V252: Transvaginal Bladder Neck Closure
VideoIntroduction and Objectives
Transvaginal closure of the bladder neck is indicated in female patients with urethral destruction resulting from long-term use of chronic indwelling urethral catheters. The transvaginal approach avoids the morbidity associated with an abdominal incision and provides a viable option for the management of the incompetent urethra.
This video shows our technique of transvaginal bladder neck closure. The patient is positioned in dorsal lithotomy position. After suprapubic catheter placement, a circumscribing incision is made around the urethra and an inverted U incision is made in the anterior vaginal wall to develop a vaginal flap. The urethra is mobilized down to the level of the bladder neck. This dissection includes the division of both the lateral (urethropelvic ligament) and anterior (pubourethral ligament) supporting structures of the urethra. The anterior urethra is then spatulated down to the bladder neck and the posterior urethra is mobilized upwards. The bladder neck is initially closed in two layers and an additional layer of closure is added with imbrication of the detrusor muscle. Lastly, the anterior vaginal flap is advanced to close the anterior vaginal wall to complete the repair.
The operative time was 2 hours and 15 minutes with an estimated blood loss of 760 cc. The patient was maintained on oxybutynin post-operatively to minimize post-operative detrusor overactivty. At 3 months postoperatively, she was doing well without evidence of urinary leakage.
Transvaginal bladder neck closure is a reasonable treatment option for patients with urethral destruction and avoids the morbidity of an abdominal incision.