Introduction

1. No. 200 Urethral reconstruction in female using anterior bladder wall without additional procedure for continence Shrawan Singh, Arup Mandal, MayankAgarwal, IbhaKumari Department of Urology, Post Graduate Institute of Medical Education & Research, Chandigarh and Department of Gynaecology, Alchemist Hospital, Panchkula, INDIA Posters Proudly Supported by: Results Two patients (50%) in group-I had voiding difficulty, used to strain at urination. One of them underwent reconstruction of continent cutaneous catheterizing stoma. Other patient developed bladder stone, underwent percutaneoussuprapubiccystolithotomy. All patients in group-II voided well with good continence. One had small trigonal fistula which was repaired successfully. Another one developed stressed urinary incontinence in 3rd trimester of pregnancy, recovered after delivery with caesarean section. Introduction Urethral reconstruction in female should aim to provide not only a patent channel with good caliber but also a continence mechanism. Tubularizing anterior bladder wall may provide continence due to criss-cross orientation of detrusor muscle and increase in intra pelvic urethral length. Aim To evaluate the outcome of reconstruction of urethra from anterior bladder wall in females. • Methods • Total loss of urethra (Group-I, n=4) was reconstructed with anterior bladder wall flap through transabdominal route assisted vaginally. A flap of 2.5 cm in width and 4 cm long was created based superiorly. The flap was tubularized over a 14 Fr Foley’s catheter and was brought retropubically to the vestivular area. The new urethra was sutured to the adjacent vaginal wall and skin to create neomeatus. • Loss of the whole posterior wall of urethra including bladder neck (Group-II, n=8) was reconstructed trans-vaginally. Two parallel para-urethral incision at 2 cm apart were made in the anterior vaginal wall and the incisions were extended cephalad 1.5 cm into the anterior bladder wall transvaginally after catheterizing the ureters and separating vagina from bladder around the fistula. Cystoscopy assisted suprapubiccystostomy was performed. The urethra was reconstructed over a Foley’s catheter of 14Fr. • Martiusflap was interposed in all the cases behind the urethra and trigone. • In one case, deficient anterior vaginal wall coverage was provided with gracillis flap covered by split thickness skin graft. • In another case, vaginal reconstruction was done with radial artery based free forearm flap. • Per urethral catheter was removed on day 7 post-operatively. Micturatingcystourethrogram was performed at 3 weeks. Urethral loss was circumferential or of the posterior wall including bladder neck Loss of the posterior wall of urethra including bladder neck Transabdominally 4cm long urethra constructed from anterior bladder wall Group-II: Both the ureters catheterized, para-urethral incision extended proximally into anterior bladder wall, urethra constructed and 1.5cm length added, martius flap interposed, vagina repaired Conclusions Urethra reconstructed with anterior bladder wall provides an excellent urinary continence without any additional procedure for continence. Cystogram and micturatingcystourethrogram showing good continence. Reconstructed urethra of adequate lumen and length can be seen