PMC5769256_01
(a and b) Preoperative cystogram and computed tomography films showing complete obliteration of the urethra beyond the level of bladder neck and communication with proximal obliterated vaginal cavity. (c) Postoperative Micturating CystoUrethrogram at 6-month follow-up
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F1
Cystogram and computed tomography scan [Figure 1a and b] revealed complete obliteration of the urethra beyond the level of bladder neck and communication with a cavity-an avulsed proximal portion of the vagina. The patient was continent and voiding well at 2 years [Figure 1c].
(a and b) Intact bladder neck, obliterated proximal urethra, no communication found with uterus. The vaginal cavity identified communicating with the proximal urethra
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F2
The obliterated proximal end of the urethra [Figure 2a] was identified by inserting a dilator through the bladder neck and dissecting the area of fibrosis. It was communicating with proximal vaginal cavity and was found to be dilated and completely obliterated [Figure 2b].
(a) Bladder mucosa selected for tubularized free graft. (b) Tube being stitched to the proximal urethra. (c) Distal end of tube being brought down and wrapped with omentum
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F3
A rectangular bladder mucosal strip was harvested as a free graft through the prior cystotomy [Figure 3a] and tubularized over a 14Fr Foley catheter to create a neourethra [Figure 3b]. Its distal end was wrapped with omentum and brought through a new opening in the introitus [Figure 3c].