To describe a novel tabularized bladder flap technique for repair of post-traumatic obliterate bladder neck and urethral stricture in women. Traumatic genitourinary injury in females is rare, and generally associated with pelvic fracture.
Obliterate bladder neck is frequent in such cases. The options for obliterate strictures are limited with Tanagho's repair as one option. Limitations of Tanagho's repair include bladder neck being shifted antero-superiorly posing voiding issues, posteriorly directed suture-line risking fistula formation with vagina and rotational tug of bladder putting tension at suture line. Here we present our initial results with our novel technique.
3 young females with bladder neck obliteration with or without associated uro-genital fistula were operated. A novel U-shaped anterior bladder wall flap was used to fashion a urethral tube and bladder neck. Native bladder neck fibres remained at bladder neck itself after reconstruction without limitation of length of urethral tube and continence outcome. Urogenital fistula was also repaired with omental interposition.
3.5, 3 and 3.5 cm tubes were fashioned in the three cases respectively. No peri-operative complications were reported. Catheter was removed at 3 weeks. All cases had normal voiding and continence at follow up of 15, 7 and 3 months respectively.
Our novel flap technique has provided good early results and aims to overcome the limitations of Tanagho's repair.
Urology. 2020 Feb 12 [Epub ahead of print]
Rishi Nayyar, Siddarth Jain, Kulbhushan Sharma, Sahil Pethe, Prashant Kumar
Department of Urology, AIIMS, New Delhi, 110029. Electronic address: ., Department of Urology, AIIMS, New Delhi, 110029.