Urethra Male / Female
The aim of this video presentation is to discribe a novel surgery technique of female ventral buccal flap urethroplasty.
44 years old female patient presented our clinic with weak urination for 20 years. In history, there was 3 three times urethral dilatation. Qmax:5,3 ml/min and PVR: 80 ml was found.
‘Pamukkale AZ’ Surgical Technique
In extended lithotomy position, nasal intubation is performed and usually 2 teams are preferred to work simultaneously at the donor and recipient sites, when available, to decrease total operation time. Oral mucosa is harvested with the help of a mouth retractor. Lidocaine and epinephrine (1:100.000) solution is injected beneath the mucosa to facilitate dissection and to decrease bleeding and postoperative pain. A 4 cm long and 2 cm wide oral mucosa is harvested. Before starting the recipient site, urethroscopy is performed with a 4.5F pediatric ureteroscope. An inverted U-shaped incision is made on the anterior vaginal wall, starting from the bladder neck extending to the urethral meatus and flap is dissected with the help of 2 retraction sutures. Urethra is dissected through the bladder neck and incised ventrally to expose the whole stricture longitudinally. Then, buccal mucosal graft is quilted to the vaginal flap with multiple 5/0 polyglactin sutures, after submucosal fat is removed meticulously. Buccal mucosatached vaginal flap is attached to the urethral incision and anastomosed (mucosa to urethra and vagina to vagina) with continuous 5/0 polyglactin sutures bilaterally. A 14F silicone Foley catheter is inserted and left for 3 weeks.
Patient was succesfully treated with this urethroplasty tecnique. Peroperative or postoperative was not observed any comlications. At the third months, Qmax was 34,1 ml/min.
This new ventral female flap urethroplasty is feasible, has lower complication rate and providing better quilting buccal graft to vaginal flap. Besides, ventral aproach provides far away from urinary sphincter and reduces incontinence risk.