Urethral closure by a transvaginal approach: step by step surgical technique

Grilo N1, Phé V2, Reus C3, Chartier-Kastler E2

Research Type

Clinical

Abstract Category

Neurourology

Abstract 246
Video Session 1 - Reconstruction
Scientific Podium Video Session 13
Wednesday 4th September 2019
17:33 - 17:42
Hall G3
Stress Urinary Incontinence Surgery Female
1.Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland, 2.Médecine Sorbonne Université, Pitié-Salpêtrière Academic Hospital, Department of Urology, Assistance Publique-Hôpitaux de Paris, Paris, France, 3.Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
Presenter
E

Emmanuel Chartier-Kastler

Links

Abstract

Introduction
Urethral closure remains a last resort treatment of stress urinary incontinence, mainly performed in patients with severe malformations of the lower urinary tract or complex neurologic patients.
Described initially as a technique for closing the bladder neck, this video describes a step by step the procedure of urethral closure by a transvaginal approach.
Design
This surgical intervention concerns a 26-year-old female patient, with the sequelae of a myelomeningocele, multi-operated in childhood, who in the past underwent an augmentation cystoplasty and a continent cutaneous diversion. She also received an autologous sling that failed to improve her stress urinary incontinence. 
In order to solve her stress urinary incontinence due to a severe intrinsic sphincter deficiency and a permanently opened bladder neck, it was decided to perform a​ urethral closure by a transvaginal approach, avoiding another dissection of the Retzius space.
Results
The steps of the intervention include:
- the exposure technique
- dissection of the urethra by a transvaginal approach with a circular per-urethral incision
- multi-layer urethral closure 
- suspension of the urethra to the pubic bone

Operative time was 75 minutes. There were no intraoperative nor  30-day complications. At last follow-up, the patient is fully continent under intermittent self catheterization through​ the continent cutaneous diversion
Conclusion
Closure of the urethra remains a rare intervention as everything must be done to preserve the urethra as much as possible in terms of continence and quality of life. Urethral closure by a transvaginal approach is a good alternative as a last resort treatment for stress urinary incontinence due to severe intrinsic sphincter deficiency. Our step by step technique of urethral closure by a transabdominal approach is reproducible and seems to be a better alternative to an abdominal approach, especially  in multi-operated and multimorbid patients
Disclosures
<span class="text-strong">Funding</span> none <span class="text-strong">Clinical Trial</span> No <span class="text-strong">Subjects</span> Human <span class="text-strong">Ethics not Req'd</span> standard practice in our center. no deviation from standard practice <span class="text-strong">Helsinki</span> Yes <span class="text-strong">Informed Consent</span> Yes