Transvaginal bladder neck closure with posterior urethral flap for devastated urethra

Area of Science:

• Urology
• Female Pelvic Medicine
• Reconstructive Surgery

Background:

• Chronic indwelling urethral catheters can cause devastating urethral and bladder neck destruction in female neurogenic patients.
• Reconstruction of such damage presents significant surgical challenges, including risks of ureteral injury and fistula formation.

Purpose of the Study:

• To introduce and evaluate a modified transvaginal bladder neck closure (TV BNC) technique.
• The modification utilizes a posterior urethral flap to enhance safety and efficacy in complex cases.

Main Methods:

• A retrospective review of 11 consecutive female patients undergoing the modified TV BNC procedure.
• The technique involves using a dorsally bivalved urethra as a flap rotated onto the anterior bladder wall for closure.
• Postoperative cystograms and serial upper tract imaging were utilized for assessment.

Main Results:

• The modified TV BNC technique demonstrated satisfactory early results in 11 patients with devastated outlets.
• One patient experienced postoperative failure at 6 weeks.
• Mean follow-up was 9.6 months, with no new hydroureteronephrosis observed on serial imaging.

Conclusions:

• The modified TV BNC with a posterior urethral flap is a safe and effective technique for reconstructing urethral and bladder neck destruction.
• This method positions the suture line away from ureteral orifices, reducing the risk of upper tract injury.
• The technique secures the closure high in the retropubic space, minimizing fistula formation and failure rates.