Vulvar carcinoma could infiltrate distal urethra, requiring complete surgical excision with negative margins. Urethral reconstruction is performed using different techniques, aiming for a maintained calibre and good cosmetic appearance.
In this educational video we aim to show a distal urethral reconstruction using oral mucosa graft in a patient with vulvar cancer involving urethra.

We present a 58 year-old patient, with past medical history of colonic cancer pT3pN1 treated with left colectomy and adjuvant chemotherapy, seeking gynecological assessment for a painful genital mass. Examination evidenced a large periclitoroideal ulcer, fixed and bleeding, extending to both labia minora. Biopsy confirmed squamous cell vulvar carcinoma, and pelvic MRI evidenced distal urethral involvement, affecting its entire circumference, with a satellite nodule anterior to left labia minora and enlarged lymph nodes in left groin.
After multidisplinary meeting, radical vulvectomy including distal urethrectomy and reconstruction using oral grafts, associated with bilateral video endoscopic inguinal lymph node dissection, is offered.

Radical vulvectomy is performed, including clitoris and labia minora, with resection of distal 2 cm of urethra –frozen section ensured negative intraoperative margins-. Ventral urethral reconstruction by suturing to anterior vaginal wall.Labial refashioning, and preparation of a surgical bed for grafting, using subcutaneous tissues.Harvest of oral mucosa graft from left cheek, measuring 4 by 2.5 cm, with closure of donor site. Dorsal incision of distal urethra, with augmentation using dorsally located oral mucosa.Bilateral video endoscopic lymph node dissection, with saphenous vein preservation and excision of deep and superficial lymphatic tissues.
Pathological diagnosis was squamous cell vulvar carcinomapT1b pN2c. Cosmetic and functional outcomes after 6 months are highly satisfactory.

In radical vulvectomy involving distal urethra, urethral augmentation using oral mucosa grafts dorsally located achieves a good calibre, a directed urinary stream and a satisfactory cosmetic outcome.