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RECONSTRUCTION   OF   FEMALE  URETHRA   BY  MEANS  OF  CLITORIDAL  ROOTS

Muscle  fibers, fibrous  and  elastic canvas and substancia propria  of  the bladder layers differ considerably from urethral tissues .

That is  why  I started  to rebuild  lost urethras  with  clitoridal roots, i.e. corpora cavernosa , whose elasto-vascular structures are much more alike. than  a  vesical  tube.

Master Plan  

Left and right :  making of the graft layer with the distal parts of  clitoridal roots. The graft is to be inserted between the inner mucosal plan and the outer vaginal cover plan.

Center : shows the insertion line of the three bundles of the ischio-cavernous muscle that are shifted,  following  local conditions, with cavernous tissues ; reminds that the  Martius graft by itself  is only a  richly vascularized fat padding tissue with no fibrous strength.

 

For  precise  technical  data   :   see  paper published articles   in   REFERENCES  page

 

Illustrations

 

Incision upon the ischiatic bone

Freeing of the clitoridal root and muscle fibers

Shifting  the distal part   to be drawn  through the vaginal wall  unto the  central line

 

Three plans reconstruction

 

  

Operating theater pictures

 

1, 2, 3,  superposing the three plans

A 10 or 12 Fr catheter is  left in place for about 12 days.  It may be passed through a buttonhole in the pubic skin in order to reduce the weight pressure on the new urethra.  Draining by  suprapubic cystostomy and  no urethral catheter  at all,  and unsticking the small adherences  afterwards , could be a better method.

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