Reconstruction of the Severely Damaged Female Urethra

The severely damaged female urethra is a rare occurrence that has two main causes—obstetric injury and surgical trauma. Obstetric injuries are exceedingly uncommon in industrial countries but not so in the Third World. Damage to the trigone, vesical neck, and urethra during delivery is thought to be the result of prolonged and neglected labor, most often associated with maternal–fetal disproportion wherein the fetal head compresses these structures against the pubis, causing pressure necrosis. Surgical damage may occur during any of the Peyrera-type bladder neck suspension procedures, anterior colporrhaphy, urethral diverticulectomy, and, much less commonly, vaginal hysterectomy. In our experience, urethral diverticulectomy is the most common cause of extensive urethral damage. This most likely results from failure to obtain a tension-free closure of the urethral defect that results from excision of the diverticulum. During bladder neck suspension, inadvertent injury to the bladder or urethra may occur, or an errant suture may result in fistula formation or tissue necrosis. We have also seen several patients who sustained extensive tissue loss after a seemingly simple Kelly plication. It is postulated that the plication sutures were tied too tightly around a urethral catheter, resulting in pressure necrosis. Read more of this post