Urethral reconstruction in the young female using a perineal pedicle flap

Five young female patients with a functionally short or absent urethra are described. Two patients had an abnormal urethra related to a congenital malformation (1 female hypospadias, 1 urogenital sinus) and three patients had an absent urethra related to previous surgery. Four of the five patients were totally incontinent of urine. Urethral reconstruction was achieved by tubularizing the mucosa of the vaginal vault and swinging a full thickness pedicle skin flap from the posterior perineum and buttock to cover the urethral repair. In two patients previously diverted, undiversion was made possible. Urinary continence has been achieved in all five patients.