Neourethral meatus reconstruction for vulvectomies requiring resection of the distal part of the urethra

Research output: Contribution to journalArticle

Abstract

Objective Vulvar cancer is a relatively rare tumour accounting for just 5% of all gynaecological malignancies. Radical excision can sometimes involve the distal one-third to one-half of the urethra leading to postoperative problems with micturition, asymmetries and psychosexual distress. Although this topic has been largely addressed, no specific method for distal urethra reconstruction has been described. The aim of this paper is to assess the safety and reliability of our reconstructive technique. Methods We conducted a retrospective study of 47 consecutive patients who underwent neourethral meatus reconstruction with vaginal mucosa flap. The surgical technique is described step-by-step. We reviewed the patients' demographics, operative characteristics, as well as immediate complications and long-term outcomes. Results Neo-meatal reconstruction was combined to direct vulvar closure in 2 patients, rhomboid flaps in 3 cases, 1 bilateral lotus flap and 36 V-Y fasciocutaneous flaps, 4 rectus abdominis and 1 gracilis flap. Wound dehiscence at the site of the neourethral reconstruction occurred in only 4.3%, partial necrosis of the vaginal mucosa flap in 2.1%. Totally post-operative early complication rate including the whole procedures was 29.8% with a re-operation rate of 4.3%. Long-term outcomes were evaluated in 68.1% patients, including 18.7% of urinary incontinence, no urethral stenosis and 25% of narrowed vaginal introitus. Conclusion Neourethral meatus reconstruction using the vaginal mucosa flap is a simple, safe and reliable technique with a very low early complication rate. We suggest that this flap could be a good option to preserve and restore urinary function in case of distal urethral amputation.

Original languageEnglish
Pages (from-to)1664-1670
Number of pages7
JournalEuropean Journal of Surgical Oncology
Volume41
Issue number12
DOIs
Publication statusPublished - Dec 1 2015

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Urethra
Mucous Membrane
Vulvar Neoplasms
Urethral Stricture
Rectus Abdominis
Urination
Urinary Incontinence
Amputation
Neoplasms
Necrosis
Retrospective Studies
Demography
Safety
Wounds and Injuries

Keywords

  • Flap
  • Neo-meatal reconstruction
  • Reconstruction
  • Vulvar cancer

ASJC Scopus subject areas

  • Oncology
  • Surgery

Cite this

@article{ff7b5ad59b6940f086b36af952b69791,
title = "Neourethral meatus reconstruction for vulvectomies requiring resection of the distal part of the urethra",
abstract = "Objective Vulvar cancer is a relatively rare tumour accounting for just 5{\%} of all gynaecological malignancies. Radical excision can sometimes involve the distal one-third to one-half of the urethra leading to postoperative problems with micturition, asymmetries and psychosexual distress. Although this topic has been largely addressed, no specific method for distal urethra reconstruction has been described. The aim of this paper is to assess the safety and reliability of our reconstructive technique. Methods We conducted a retrospective study of 47 consecutive patients who underwent neourethral meatus reconstruction with vaginal mucosa flap. The surgical technique is described step-by-step. We reviewed the patients' demographics, operative characteristics, as well as immediate complications and long-term outcomes. Results Neo-meatal reconstruction was combined to direct vulvar closure in 2 patients, rhomboid flaps in 3 cases, 1 bilateral lotus flap and 36 V-Y fasciocutaneous flaps, 4 rectus abdominis and 1 gracilis flap. Wound dehiscence at the site of the neourethral reconstruction occurred in only 4.3{\%}, partial necrosis of the vaginal mucosa flap in 2.1{\%}. Totally post-operative early complication rate including the whole procedures was 29.8{\%} with a re-operation rate of 4.3{\%}. Long-term outcomes were evaluated in 68.1{\%} patients, including 18.7{\%} of urinary incontinence, no urethral stenosis and 25{\%} of narrowed vaginal introitus. Conclusion Neourethral meatus reconstruction using the vaginal mucosa flap is a simple, safe and reliable technique with a very low early complication rate. We suggest that this flap could be a good option to preserve and restore urinary function in case of distal urethral amputation.",
keywords = "Flap, Neo-meatal reconstruction, Reconstruction, Vulvar cancer",
author = "{De Lorenzi}, F. and P. Loschi and M. Rietjens and C. Sangalli and A. Manconi and V. Zanagnolo and Achilarre, {M. T.} and A. Maggioni and F. Landoni",
year = "2015",
month = "12",
day = "1",
doi = "10.1016/j.ejso.2015.07.017",
language = "English",
volume = "41",
pages = "1664--1670",
journal = "European Journal of Surgical Oncology",
issn = "0748-7983",
publisher = "W.B. Saunders Ltd",
number = "12",

}

TY - JOUR

T1 - Neourethral meatus reconstruction for vulvectomies requiring resection of the distal part of the urethra

AU - De Lorenzi, F.

AU - Loschi, P.

AU - Rietjens, M.

AU - Sangalli, C.

AU - Manconi, A.

AU - Zanagnolo, V.

AU - Achilarre, M. T.

AU - Maggioni, A.

AU - Landoni, F.

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Objective Vulvar cancer is a relatively rare tumour accounting for just 5% of all gynaecological malignancies. Radical excision can sometimes involve the distal one-third to one-half of the urethra leading to postoperative problems with micturition, asymmetries and psychosexual distress. Although this topic has been largely addressed, no specific method for distal urethra reconstruction has been described. The aim of this paper is to assess the safety and reliability of our reconstructive technique. Methods We conducted a retrospective study of 47 consecutive patients who underwent neourethral meatus reconstruction with vaginal mucosa flap. The surgical technique is described step-by-step. We reviewed the patients' demographics, operative characteristics, as well as immediate complications and long-term outcomes. Results Neo-meatal reconstruction was combined to direct vulvar closure in 2 patients, rhomboid flaps in 3 cases, 1 bilateral lotus flap and 36 V-Y fasciocutaneous flaps, 4 rectus abdominis and 1 gracilis flap. Wound dehiscence at the site of the neourethral reconstruction occurred in only 4.3%, partial necrosis of the vaginal mucosa flap in 2.1%. Totally post-operative early complication rate including the whole procedures was 29.8% with a re-operation rate of 4.3%. Long-term outcomes were evaluated in 68.1% patients, including 18.7% of urinary incontinence, no urethral stenosis and 25% of narrowed vaginal introitus. Conclusion Neourethral meatus reconstruction using the vaginal mucosa flap is a simple, safe and reliable technique with a very low early complication rate. We suggest that this flap could be a good option to preserve and restore urinary function in case of distal urethral amputation.

AB - Objective Vulvar cancer is a relatively rare tumour accounting for just 5% of all gynaecological malignancies. Radical excision can sometimes involve the distal one-third to one-half of the urethra leading to postoperative problems with micturition, asymmetries and psychosexual distress. Although this topic has been largely addressed, no specific method for distal urethra reconstruction has been described. The aim of this paper is to assess the safety and reliability of our reconstructive technique. Methods We conducted a retrospective study of 47 consecutive patients who underwent neourethral meatus reconstruction with vaginal mucosa flap. The surgical technique is described step-by-step. We reviewed the patients' demographics, operative characteristics, as well as immediate complications and long-term outcomes. Results Neo-meatal reconstruction was combined to direct vulvar closure in 2 patients, rhomboid flaps in 3 cases, 1 bilateral lotus flap and 36 V-Y fasciocutaneous flaps, 4 rectus abdominis and 1 gracilis flap. Wound dehiscence at the site of the neourethral reconstruction occurred in only 4.3%, partial necrosis of the vaginal mucosa flap in 2.1%. Totally post-operative early complication rate including the whole procedures was 29.8% with a re-operation rate of 4.3%. Long-term outcomes were evaluated in 68.1% patients, including 18.7% of urinary incontinence, no urethral stenosis and 25% of narrowed vaginal introitus. Conclusion Neourethral meatus reconstruction using the vaginal mucosa flap is a simple, safe and reliable technique with a very low early complication rate. We suggest that this flap could be a good option to preserve and restore urinary function in case of distal urethral amputation.

KW - Flap

KW - Neo-meatal reconstruction

KW - Reconstruction

KW - Vulvar cancer

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U2 - 10.1016/j.ejso.2015.07.017

DO - 10.1016/j.ejso.2015.07.017

M3 - Article

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JO - European Journal of Surgical Oncology

JF - European Journal of Surgical Oncology

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