V1-01: W-V flap: A new procedure for reconstruction of female distal urethra

Video

Introductions and Objectives
To demonstrate a new procedure utilizing local flaps of vestibular mucosa for reconstruction of distal urethra in women with totally obliterative urethral stricture.

Methods
A 34-years old lady presented with suprapubic catheter placed elsewhere to manage acute urinary retention following failed dilatation of distal urethral stricture. After informed consent, she underwent W-V flap urethroplasty in regional anesthesia and lithotomy position. A "W-shaped" area was demarcated in front and sides of urethral orifice in a manner that the base of 'W' faced towards the clitoris; each half of W descended on either side of urethral orifice for about 2.5 cms and the original orifice itself remained in the centre. Each half of W was raised as two separate V shaped flaps (base at 12 o'clock). The distal 1 cm of strictured urethra was dissected circumferentially and excised. The medial edges of two flaps representing halves of 'W' were sutured to each other converting the 'W' into 'V'. The apex of 'V' was sutured circumferentially to the distal edge of urethra using interrupted absorbable sutures. The juxtaurethral part of flap was tubularised by suturing the lateral edges of flap together thus making a centimeter long neourethra. A 16 F foley catheter was placed through the tubularised flap and native urethra.

Results
The procedure took 80 minutes and estimated blood loss was less than 50 cc. The patient remained on indwelling urethral catheter as well as a SPC for 12 days after which she resumed normal continent voiding with a Qmax of 25 ml/sec and remained well till last follow up at 3 months. Her stream had normal forward direction but splayed.

Conclusions
This procedure created a cone shaped tube from vestibular mucosa and provided an effective and simple alternative for distal urethral reconstruction. It maintained the normal forward direction of urinary stream. Further studies on larger number of patients are needed to standardize the procedure.

Funding: Nil