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RECONSTRUCTION  OF FEMALE URETHRA  AND  OF ITS  FIBROUS SUPPORT

 

 

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.

 

  OPERATION  PLAN

 

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

 

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

 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.

 

The superficial vaginal layer of the fold is being withdrawed.

 Dissection of the fold.

 The freed fold.

 

 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

    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.

Very excessive vaginal coverings to be resected.

Wide superposition

Final aspect final after resection of vaginal excess tissues.

Gauze padding

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Anatomy of the suburethral fascia