Use of Vaginal Flaps and Pubovaginal Sling in Urethral Reconstruction PD09-PD10
Dr. Kishan K Raj,
Department of Urology, Sri Sathya Sai Institute of Higher Medical Sciences, Puttaparthi, Anantpur, Andhra Pradesh, India.
The delayed or prolonged second stage of labour occurs when the foetal head exert pressure against the anterior vaginal wall and it results in ischemia and necrosis of bladder base and urethra. The ischaemic injury can result in Vesicovaginal Fistula (VVF) and Urethrovaginal Fistula (UVF). Most of the time it is related to Stress Urinary Incontinence (SUI) because of wearing out of sphincter mechanism. The index case is of a 43-year-old female who presented with total incontinence. Patient had previously undergone transvaginal fistula closure for UVF resulting from obstructed labour. On evaluation she was found to have UVF and SUI. She underwent simultaneous urethral reconstruction and pubovaginal sling surgery for SUI. Patient is currently continent and has satisfactory voiding. Simultaneous pubovaginal sling along with urethral reconstruction is a safe and feasible procedure in managing such patients.