Transvaginal closure of urinary bladder opening and Mitrofanoff technique in a neurologically impaired female with chronic indwelling catheter: a case presentation.

Chronic catheterization remains the only attractive option in specific circumstances, especially in neurologically impaired patients. Complications produced by the indwelling catheters, like patulous urethra and bladder neck destruction, usually lead to severe incontinence and significant nursing difficulties. Here, we describe a rare case, a urinary bladder opening representing massive and extensive destruction of the urethra and bladder sphincter due to an indwelling catheter.

We present a 46-year-old paraplegic woman complaining of recurrent febrile urinary tract infections and severe urinary incontinence. She suffered from persistent malodorous urine and skin breakdowns from constant urine leakage. The vaginal examination revealed extensive destruction of the urethra and a 10 cm opening permitting the urinary bladder wall to prolapse into the vagina. The patient underwent a combined surgical approach; a transvaginal bladder closure with anterior colporrhaphy and a Mitrofanoff procedure to ensure a continent stoma for future clean intermittent self-catheterization (CISC). The patient is compliant with CISC and, remains continent twelve years after surgery.

This case demonstrates that in the era of CISC, there are still neurologically impaired females suffering from rare but critical adverse effects of indwelling catheters. The urethra and bladder neck erosion represent a demanding treatment assignment. The Mitrofanoff procedure for continent stoma and the transvaginal closure of urinary bladder opening produced a lifesaving potential treatment.

BMC urology. 2021 Jun 27*** epublish ***

Zachariou Athanasios, Paschopoulos Minas, Kaltsas Aris, Dimitriadis Fotios, Zikopoulos Athanasios, Mamoulakis Charalampos, Takenaka Atsushi, Sofikitis Nikolaos

Urology Department, Medical School, University of Ioannina, Ioannina, Greece. ., Department of Obstetrics and Gynaecology, Medical School, University of Ioannina, Ioannina, Greece., Urology Department, Medical School, University of Ioannina, Ioannina, Greece., Urology Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece., Urology Department, Medical School, University of Crete, Heraklion, Greece., Urology Department, Medical School, Tottori University, Yonago, Japan.

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