Vaginal flap reconstruction of the urethra and vesical neck in women: A report of 49 cases

Purpose: A retrospective study was done to evaluate the results of a 1- stage urethral reconstruction in women. Materials and Methods: Of 49 consecutive women who presented with anatomical damage to the urethra or vesical neck 48 underwent urethral and/or vesical neck reconstruction with vaginal flaps. A Martius labial fat pad flap was used in 47 patients, a gracilis flap in I and an anterior bladder tube in 1. In 41 patients the anti-incontinence procedure consisted of a fascial pubovaginal sling placed over the labial fat pad flap without tension. In 5 patients a modified Pereyra operation was done and 1 underwent a Kelly plication. Followup ranged from 1 to 11 years. Results: Postoperatively continence was obtained in 42 of 49 patients (87%). The initial procedure failed in 7 patients and a secondary procedure was successful in 6. Of the 5 initial patients who underwent a modified Pereyra operation 3 had postoperative stress incontinence and all were cured subsequently by a pubovaginal sling. Conclusions: A 1-stage vaginal flap reconstruction and pubovaginal sling procedure is effective in women with extensive vesical neck and/or urethral damage.