The management of female urethral defects is usually a painstaking urological challenge. The nature of the anomaly, whether
it is congenital or acquired, and the degree of urethral tissue loss affect the surgical outcome. Different principles have
been adopted to repair this problem with the 2 goals of replacement of the urethra and restoration of continence. Urethral replacement can be accomplished by anterior bladder wall (Tanagho) 1  tube or tubularization of vaginal mucosa (vaginal wall flap replacement)2. The Interposition of supporting tissue, such as the anterior rectus sheath could be used in conjunction. Restoration of continence is also achieved by an autologous rectus fascia sling. The integration of such principles is sought in the pursuit of proper correction of urethral loss.

JGA is a 37-year-old lady with a history of surgical defloration shortly after marriage. The procedure ended up by massing laceration of the ventral urethra and severe urine incontinence. She has been maintained on 5-7 diapers per day. she was referred to our facility 1 year after this trauma. Under spinal anesthesia, Panendoscopy revealed a short(1.5 cm) wide urethra. The patient underwent the creation of a urethral tube from vaginal tissue. The neourethra was covered by a rectus fascia sling that was harvested from a separate Pfannenstiel incision. the sling was tension-free. and the vaginal mucosa was reconstructed to cover the neiurethra.18 F silicone catheter and vaginal pack were left.

The patient had an eventful postoperative course. The vaginal pack was removed after 48 hours and she was discharged home safely. After 14 days the urethral catheter was taken out and the patient was taught CIC. She continued on CIC with frequent estimation of bladder capacity with gradual prolongation of catheter intervals. After 6 weeks the lady was able to void spontaneously with PVR of less than 50 ml. She was last seen 1 year after surgery and is totally dry with 35 ml residual urine and normal sexual intercourse.

The combination of anterior vaginal flap and rectus fascia sling is a good option in the treatment of complex urethral trauma associated with severe degree incontinence

Tanagho EA: Bladder neck reconstruction for total urinary incontinence: 10 years of experience. J Urol 1981; 125: 321.
Blaivas JG: Vaginal flap urethral reconstruction: an alternative to the bladder flap neo-urethra. J Urol 1989; 141: 542.