41- year old lady who had major urethral injury following perineal trauma. For one and half years. Was totally incontinence and using 5 pads per day on average.

This video demonstrates the creation of an anterior vaginal wall flap. This was used to replace the lost urethral wall. Then I demonstrated harvesting and preparation of a rectus sheath graft, used as a sling to augment the urethra repair and provide extra support to maintain continence. The urethral catheter was left for 3 weeks

The lady had frequency, urgency, and urge incontinence after catheter removal. With timed voiding and antimuscarinic therapy, the patient was able to void every 4 hours with no urge incontinence. Stress test and 1-hour pad test were negative 1 year after surgery

The concomitant repair of urethral injuries, using vaginal wall flap urethroplasty and rectus facia sling is a very good and successful option to treat such major rare injuries