Anterior bladder flap neo urethra as treatment for stress urinary incontinence due to developmental urogenital anomaly

Congenital anomalies that involve the distal segment of urogenital sinus [giving rise to female urethra and vagina] may lead to abnormal urethral development ranging from absent to markedly deficient urethra. The abnormal division may also cause a short and patulous urethra. Sphincteric defects are likely to be associated and when combined with the short urethral length is a cause for severe urinary incontinence. Urinary incontinence due to a congenital cause requiring repeated urethral reconstruction to relieve symptoms is presented. A 15 year old girl was referred for bothersome urinary incontinence due to a short, wide, patulous urethra with defective sphincteric mechanism as part of urogenital sinus developmental anomaly. She was initially managed by reconstruction of bladder neck and proximal urethra with sphincter augmentation using autologous pubovaginal sling. Persistent urinary incontinence demanded a second urethral reconstruction using tubularised anterior bladder flap [modified Tanagho]. Surgical reconstruction of the urethra achieved socially acceptable continence.

Trans-vaginal repair of gynecological supratrigonal vesicovaginal fistulae: a worthy option!

To determine the appropriateness of vaginal approach for gynecological supratrigonal vesicovaginal fistulae. Retrospective review of consecutive women with gynecological supratrigonal Vesico Vaginal Fistulae [VVF] repaired at the fistula unit of Urogynecology department between 1996 and 2011 was done.Out of 48 cases of supratrigonal VVF of gynecological origin identified; 34 [70.8%] cases were repaired vaginally and 14 [36.8%] abdominally with a mean follow-up period of 52.8 [2-132] months. Overall 95.8% were successfully cured at first attempt. The success rate of vaginal repair [94.8%] at first attempt was comparable to that of abdominal repair [100%] [P value = 0.8946]. Amongst two failed vaginal repairs, one was successfully cured by subsequent vaginal repair and other by abdominal repair. Three fourth gynecological supratrigonal VVF can be repaired vaginally in first attempt with success rate comparable to abdominal approach. On the basis of this study we postulate that vaginal approach should be preferred over abdominal approach for repair of all vaginally accessible supratrigonal VVF of gynecological origin