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Urethral Substitution in Women
Author(s) -
MUNDY A. R.
Publication year - 1989
Publication title -
british journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 0007-1331
DOI - 10.1111/j.1464-410x.1989.tb05129.x
Subject(s) - medicine , neck of urinary bladder , surgery , urethra , sinus (botany) , urinary incontinence , sphincter , cuff , artificial urinary sphincter , vagina , urology , stress incontinence , urinary bladder , botany , biology , genus
Summary— A series of 30 female patients underwent total urethral substitution for a variety of conditions, usually urogenital sinus abnormalities or post‐irradiation vesicourethrovaginal fistulae. Five different techniques were used: bladder flap neourethroplasty, neourethroplasty using a urinary tract remnant, vaginal/urogenital sinus neourethroplasty, pedicled labial skin tube neourethroplasty and colonic substitution neourethroplasty with synchronous implantation of an artificial sphincter. Bladder flap neourethroplasty is appropriate if the bladder size is adequate and if the bladder neck is incompetent, but stress incontinence is a common complication which must be anticipated and dealt with proleptically. Vaginal/UG sinus neourethroplasty is preferred if the bladder neck is competent enough to preserve continence. When no other tissue is available, particularly after radiotherapy, a pedicled labial skin tube neourethroplasty gives the best results. Colonic substitution with the implantation of an artificial sphincter is not satisfactory. Any surgically created neourethra should be wrapped with either labial fat pads or omentum and, in the absence of a competent bladder neck, with an artificial sphincter cuff to support the urethra and to prevent it telescoping, and for use as a back‐up if continence is not adequate.