V12-10: Urethroplasty: Urethral-Clitoral Ectopy
Female urethral duplication is an extremely rare congenital anomaly with multiple hypotheses to describe its etiology. We present the surgical management of a woman with partial urethral duplication present in the glans clitoris and concurrent stricture of the orthotopic urethra.
Our patient is a 38-year old woman with a congenitally solitary right kidney who has had a urethral stricture for over 20 years requiring monthly dilations. She has a partial urethral duplication opening on the glans clitoris from which she voids when her stricture recurs and her true urethra narrows. She elected to have the urethral stricture excised, without removal of the accessory urethra in the glans clitoris. The urethral stricture was managed using the Blandy vaginal flap urethroplasty technique. The intraoperative use of a nasal speculum is illustrated in the video to aid with intraurethral visualization.
The patient had resolution of her voiding dysfunction, with decrease in post-void residual volume from 393mL preoperatively to 108mL at follow-up. A normal external appearance of clitoris and vagina postoperatively is illustrated. She has rare drops of urine to no outflow from her clitoral accessory urethra.
Vaginal flap urethroplasty can successfully treat a distal urethral stricture and avoid excision of a urethral duplication anomaly, which may compromise sexual function.