urethrovaginal fistula urethral reconstruction n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Urethrovaginal Fistula & Urethral Reconstruction PowerPoint Presentation
Download Presentation
Urethrovaginal Fistula & Urethral Reconstruction

Loading in 2 Seconds...

play fullscreen
1 / 70

Urethrovaginal Fistula & Urethral Reconstruction - PowerPoint PPT Presentation


  • 232 Views
  • Uploaded on

Urethrovaginal Fistula & Urethral Reconstruction. Jerry G. Blaivas, MD Clinical Professor of Urology New York Hospital Cornell Medical Center Adjunct Professor of Urology SUNY-Downstate Medical Center. Etiology of Damaged Urethra. Complication of Urethral Diverticular Surgery.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Urethrovaginal Fistula & Urethral Reconstruction' - edward-alexander


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
urethrovaginal fistula urethral reconstruction
Urethrovaginal Fistula & Urethral Reconstruction

Jerry G. Blaivas, MD

Clinical Professor of Urology

New York Hospital

Cornell Medical Center

Adjunct Professor of Urology

SUNY-Downstate Medical Center

slide5

Eroded sling

Fistula

diverticulum

slide11

Foley catheter

Stoneson sutures

Fistula

diagnosis
Diagnosis
  • High index of suspicion:
    • post-vaginal / urethral surgery
    • synthetic sling
    • difficult childbirth
    • pelvic fracture
  • Vaginal examination:
    • witness urine loss from urethra
    • Occlude meatus with finger during cough
    • Look for urine loss proximal to meatus
  • Cystoscopy
urethral reconstruction
Urethral Reconstruction
  • Posterior bladder flap(Young-Dees-Leadbetter)
  • Anterior bladder flap(Tanagho)
  • Vaginal wall / labial flap
vaginal repair
Vaginal Repair
  • Primary closure
  • Lateral flap
    • Unilateral vaginal wall pedicle flap
    • Bilateral vaginal wall pedicle
  • Advancement flap
  • Labial minora island pedicle flap
  • Buccal graft
judicious use of vascularized pedical flaps
Judicious Use of VascularizedPedical Flaps
  • Martius labial fat pad
  • Omentum
  • Rectus abdominis
  • Gracilis
  • Singapore
vaginal repair1
Vaginal Repair
  • Primary closure
  • Flaps
    • Lateral vaginal pedicle flap
    • Advancement flap
    • Labial minora peninsula pedicle flap
    • Labial minora island pedicle flap
  • Buccal mucosal graft
vaginal repair2
Vaginal Repair
  • Primary closure
  • Flaps
    • Lateral vaginal pedicle flap
    • Advancement flap
    • Labial minora peninsula pedicle flap
    • Labial minora island pedicle flap
  • Buccal mucosal graft
vaginal repair3
Vaginal Repair
  • Primary closure
  • Flaps
    • Lateral vaginal pedicle flap
    • Advancement flap
    • Labial minora peninsula pedicle flap
    • Labial minora island pedicle flap
  • Buccal mucosal graft
vaginal repair4
Vaginal Repair
  • Primary closure
  • Flaps
    • Lateral vaginal pedicle flap
    • Advancement flap
    • Labial minora peninsula pedicle flap
    • Labial minora island pedicle flap
  • Buccal mucosal graft
slide49

Bladder neck

Labiamajora

Labiamajora

vaginal repair5
Vaginal Repair
  • Primary closure
  • Flaps
    • Lateral vaginal pedicle flap
    • Advancement flap
    • Labial minora peninsula pedicle flap
    • Labial minora island pedicle flap
  • Buccal mucosal graft
vaginal repair6
Vaginal Repair
  • Primary closure
  • Flaps
    • Lateral vaginal pedicle flap
    • Advancement flap
    • Labial minora peninsula pedicle flap
    • Labial minora island pedicle flap
  • Buccal mucosal graft
potential complications
Potential Complications
  • Urethral obstruction
  • Hemorrhage
  • Ureteral obstruction
  • Vesciovaginal fistula
  • Sphincteric incontinence
conclusions
Conclusions
  • Vaginal repair is possible in almost all patients
  • Most patients with pre-op SUI shouldhave synchronous anti-incontinenceop +/- Martius flap
  • Successful outcome is achievablein over 85% of patients