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Urethrovaginal Fistula & Urethral Reconstruction

Urethrovaginal Fistula & Urethral Reconstruction. Jerry G. Blaivas, MD Clinical Professor of Urology New York Hospital Cornell Medical Center Adjunct Professor of Urology SUNY-Downstate Medical Center. Etiology of Damaged Urethra. Complication of Urethral Diverticular Surgery.

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Urethrovaginal Fistula & Urethral Reconstruction

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  1. Urethrovaginal Fistula & Urethral Reconstruction Jerry G. Blaivas, MD Clinical Professor of Urology New York Hospital Cornell Medical Center Adjunct Professor of Urology SUNY-Downstate Medical Center

  2. Etiology of Damaged Urethra

  3. Complication of Urethral Diverticular Surgery

  4. Eroded sling Fistula diverticulum

  5. Complication of Synthetic Sling

  6. Granulationtissue Fistula

  7. Complication of Colporraphy

  8. Ureteralorifices

  9. Foley catheter Stoneson sutures Fistula

  10. Sterile Abscess from Periurethral Injection

  11. Complication of Pelvic Fracture

  12. Complication of Foley Catheter

  13. Squamous Cell Carcinoma

  14. Diagnosis • High index of suspicion: • post-vaginal / urethral surgery • synthetic sling • difficult childbirth • pelvic fracture • Vaginal examination: • witness urine loss from urethra • Occlude meatus with finger during cough • Look for urine loss proximal to meatus • Cystoscopy

  15. Urethral Reconstruction • Posterior bladder flap(Young-Dees-Leadbetter) • Anterior bladder flap(Tanagho) • Vaginal wall / labial flap

  16. Vaginal Repair • Primary closure • Lateral flap • Unilateral vaginal wall pedicle flap • Bilateral vaginal wall pedicle • Advancement flap • Labial minora island pedicle flap • Buccal graft

  17. Judicious Use of VascularizedPedical Flaps • Martius labial fat pad • Omentum • Rectus abdominis • Gracilis • Singapore

  18. Vaginal Repair • Primary closure • Flaps • Lateral vaginal pedicle flap • Advancement flap • Labial minora peninsula pedicle flap • Labial minora island pedicle flap • Buccal mucosal graft

  19. Vaginal Repair • Primary closure • Flaps • Lateral vaginal pedicle flap • Advancement flap • Labial minora peninsula pedicle flap • Labial minora island pedicle flap • Buccal mucosal graft

  20. Vaginal Repair • Primary closure • Flaps • Lateral vaginal pedicle flap • Advancement flap • Labial minora peninsula pedicle flap • Labial minora island pedicle flap • Buccal mucosal graft

  21. Vaginal Repair • Primary closure • Flaps • Lateral vaginal pedicle flap • Advancement flap • Labial minora peninsula pedicle flap • Labial minora island pedicle flap • Buccal mucosal graft

  22. Bladder neck Labiamajora Labiamajora

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