Hypothesis: Radical urethrectomy with vaginal wall pedicle flap urethral reconstruction achieves complete tumor eradication while preserving or restoring urinary continence in female patients with primary urethral cancer (PUC), offering a safe and effective surgical approach.  
Aim of Study: This study describes the clinical outcomes of vaginal wall pedicle flap urethral reconstruction following radical urethrectomy for female PUC, evaluating its oncological efficacy, urinary continence rates, and long-term safety.

Study Design, Materials, and Methods: A retrospective analysis was conducted on 223 female patients (mean age: 58.3 years; range: 26–83 years) who underwent radical urethrectomy for PUC between August 2010 and December 2022. All tumors were excised with a surgical margin exceeding 2 cm. Patients were stratified into two cohorts:  
1. Early-stage group (n=211): Primary urethral reconstruction was performed using a vaginal wall pedicle flap with preservation of the native bladder sphincter.  
2. Total urethrectomy group (n=12): Patients requiring full urethral excision underwent staged reconstruction, including bladder neck reconstruction, artificial urinary sphincter implantation, and tubularized vaginal wall pedicle flap urethroplasty.  
Postoperative follow-up spanned 2–14 years (median: 8.2 years), with assessments for tumor recurrence (clinical exams, imaging) and urinary continence (24-hour pad test). Complications, including flap viability and sphincter function, were systematically documented.

Results:  
- Oncological Outcomes: No local or distant tumor recurrence was observed during the follow-up period.  
- Urinary Continence: Complete continence (0 g/24-hour pad weight) was achieved in 222 patients (99.6%). One patient (0.4%) in the total urethrectomy group exhibited mild stress incontinence (5 g/24-hour pad weight).  
- Surgical Safety: No major perioperative complications (e.g., flap necrosis, urethral stricture, or infection) occurred. All artificial sphincters (n=12) remained functional without mechanical failure or revision.

Interpretation of Results:  
The absence of recurrence validates the adequacy of ≥2 cm surgical margins for PUC resection. The vaginal wall pedicle flap technique demonstrated dual advantages:  
1. Anatomic Preservation: In early-stage cases, sphincter-sparing reconstruction maintained physiological urinary control mechanisms.  
2. Functional Restoration: For advanced tumors requiring total urethrectomy, the combination of bladder neck reconstruction, artificial sphincters, and tubularized flaps successfully replicated urethral anatomy and continence function.  
The 99.6% continence rate highlights the procedure’s precision in balancing radical oncologic resection with functional preservation. The lack of flap-related complications underscores the reliability of vaginal tissue for reconstruction, attributable to its vascularity and proximity to the surgical site.

Concluding Message:  
Vaginal wall pedicle flap urethral reconstruction following radical urethrectomy is a definitive treatment for female PUC, offering unparalleled oncological control and exceptional functional outcomes. The technique’s adaptability—preserving sphincters in early-stage disease and integrating artificial sphincters in advanced cases—ensures tailored, patient-centric care. With no recurrences and near-perfect continence rates over a median 8.2-year follow-up, this approach establishes a new benchmark for treating female urethral cancer, prioritizing both survival and quality of life. These findings advocate for its adoption as a standard surgical strategy, particularly in centers specializing in urologic oncology and reconstructive surgery. Further multicenter studies are warranted to validate these results across diverse populations.