RECONSTRUCTION OF FEMALE URETHRA AND OF ITS FIBROUS SUPPORT
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OPERATIVE TIMES : 1) incising the vaginal wall and the underlying fascia in the sagittal plane 2) freeing the urethra and recontructing its natural width and length 3) freeing the distended suburethral fascia to obtain a left and a right wing 4) retightening the fascia by superposition of both wings This exclusively vaginal access allows one-time treatment of cystocele, rectocele, uterine ptosis , vulvo-vaginal gaping The general aim of the operation is to reconstruct the native architecture. Therefore it has been used to treat various urethral strictures, urethral diverticulae and some similar pathologies as well as common stress incontinence.
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OPERATION PLAN
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1. The natural normal suburethral fascia 2. Uro-genital ptosis. . a. The suburethral fold underneath the reclined vaginal wall. 3. Dissection of the fold extended to the lateral wings of the fascia b. Freeing the urethra c. the left and right fascial wings |
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4. Restoring the canal by fine sutures on its 3 layers. d. e. Superposition of the wings.
5. The urethra is now subtended by a doubled fibrous layer. |
OPERATION PICTURES
Common stress Incontinence without significant uro-genital ptosis
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300 ml. of water are put into the bladder. Manual expression test objectivizes the incontinence caused by loosening of the contention fascia. The same test is performed at the end of the operation to control the resulting continence.
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The superficial vaginal layer of the fold is being withdrawed. |
Dissection of the fold. |
The freed fold.
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Sagittal incision unto the external muscular layer of the urethra. |
Freeing the urethral canal. |
Simple case where left and right fascial wings are beeing superposed in an overcoat-like manner. Making of a 2 cm fibrous band at a physiological tension. |
Simple case where closing the vaginal wall needs no resection. |
Stress Incontinence with important urogenital ptosis
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Cytoptosis, urethral gaping, moderate vaginal distension, only small suburethral fold |
Multiparous women. Important ptosis. Well developed suburethral fold. |
Very wide left and right fascial wings. |
Very wide superposition. Excess vaginal wall to be resected. |
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Very excessive vaginal coverings to be resected. |
Wide superposition |
Final aspect final after resection of vaginal excess tissues. |
Gauze padding |
