"Labia Majora Fasciocutaneous Flap Reconstruction in Complex Urogynecological Fistulas With Vaginal Deficit - A Versatile Approach".

OBJECTIVE: To appraise the pivotal points of different modifications of labia majora fasciocutaneous flap in combating the challenges of complex urogynecological fistula repair in the form of 7 cases. METHODS: Seven patients with complex urogynecological fistulas with vaginal deficit were treated over last 3 years. The challenges associated with them were non-capacious rigid vagina, irradiated and inflamed surrounding tissues, inelasticity, long-standing fistula with radiation-induced vesicovaginal fistula(VVF), an iatrogenic urethrovaginal fistula with anterior vaginal wall loss with vaginal stenosis, and a case of vesicolabial fistula with a history of forceps delivery and transvaginal VVF repair. Transvaginal repair with labia majora fasciocutaneous flap along with fat pad with relevant technical modifications was contemplated in all. RESULTS: All radiation-induced VVF patients demonstrated no leak in the postoperative period barring one who became dry after transvaginal colpocleisis later. The patient with urethrovaginal fistula and vaginal stenosis was continent, had capacious vagina, and without any leak with regular menstrual periods. The female with vesicolabial fistula remained dry at the end of 6-month follow-up. CONCLUSION: Transvaginal repair using the labia majora fasciocutaneous flap and the demonstrated technical modifications can be a feasible option in repairing complex urogynaecological fistulas associated with vaginal wall deficit.

Clinical and videourodynamic study characteristics in female primary bladder neck obstruction and outcomes of bladder neck resection: A tertiary care center experience in India.

Introduction: Video urodynamic study (VUDS) with clinical correlation helps in diagnosing primary bladder neck obstruction (PBNO) in women. Bladder neck incision/bladder neck resection (BNR) though effective is not commonly practiced for the fear of complications and limited literature available. Methods: The records of ten women diagnosed with PBNO between 2017 and 2019 were reviewed and data pertaining to their clinical features, laboratory results, findings on abdominal ultrasonography, uroflowmetry, and VUDS was noted. Type of operative procedure performed and outcomes on follow-up were also assessed. Results: Out of ten patients, two presented with lower urinary tract symptoms (LUTS), three with voiding LUTS and chronic retention and five had acute urinary retention. Mean serum creatinine was 3.4 mg/dl. In those able to void, mean maximum flow rate (Q max) was 7 ml/sec, and mean postvoid residual volume (PVR) was 360 ml. On VUDS, mean detrusor pressure at maximum flow (pdet@Qmax) was 54.2 cm of H20. Three patients opted conservative treatment and 7 had a successful surgical outcome with mean Q max of 26.2 ml/s (range: 13.9-41 ml/s), insignificant PVR and resolution of renal failure. Patients with pdet@Qmax <20 cm H2O (n = 3, mean 18.3 cm H2O) did equally well as compared to those with pdet@Qmax >20 cm H2O (n = 4, mean 93 cm H2O). None of the patients developed any complications on follow-up. Conclusions: Clinical assessment supported with VUDS correlation holds a key in identifying patients with PBNO. BNR is a safe and effective treatment of PBNO in women who fail or are not candidates for conservative treatment.

Dorsal Onlay Buccal Mucosal Graft Urethroplasty in Post Radiation Female Urethral Stricture - A Technical Appraisal With Outcomes.

INTRODUCTION AND OBJECTIVES: Female urethral stricture following radiation has been reported sparsely in the literature with just a handful of case reports. Radiation to the pelvis affects the genitourinary tracts and afflicts damage by causing periurethral fibrosis, necrosis, and subsequent tissue contraction, posing as a hurdle to the reconstructive surgeon. We studied the technique and outcomes of dorsal onlay buccal mucosal graft (BMG) urethroplasty in patients of radiation-induced female urethral stricture disease (FUSD). MATERIALS AND METHODS: Three cases of radiation-induced FUSD were reviewed. The preoperative and postoperative parameters like IPSS, Flow rate (Qmax), Postvoid residue (PVR), urethroscopy findings, and Videourodynamics study parameters were analyzed. All patients underwent dorsal onlay BMG urethroplasty. The salient steps of the operative procedure are demonstrated in this video presentation. RESULTS: The mean duration after the last radiation cycle was 2.33 years. Preoperatively mean IPSS, Qmax, and PVR were 27.33 ± 1.15, 6.46 ± 0.6 mL/s, and 56.67 ± 16.07 mL, respectively. After dorsal onlay BMG urethroplasty the mean IPSS, Qmax, and PVR were 3.33 ± 1.5, 23.33 ± 6.1 mL/s, 15.67 ± 8.14 mL, respectively. None of the patients reported bothersome lower urinary tract symptoms, and stricture recurrence in the 12-month follow-up. However, one patient had transient stress incontinence, which was managed conservatively. CONCLUSION: Dorsal onlay BMG urethroplasty achieves excellent outcomes in patients with postradiation FUSD. Adequate dorsal urethrotomy should be contemplated in previously irradiated strictures.