Case presentation

The patient was a 37 year old woman presented with true incontinency. She suffered from incontinency from 14 years ago after obstructed labor.The patient has some episodes of urinary tract infection in the previous years ago. She had undergone five different surgeries  consist of cystocele repair (12 years ago), Burch (10 years ago), two times sling (8 and 3 years ago) and vesicovaginal fistula repair (1 year ago)for management of incontinency in the other centers, but no improvement was made. 

Cystoscopy

There was no anterior urethra and total length of urethra decreased to 1.5 cm. Balloon of the Foley catheter was visible from bladder neck. Tape from the previous sling operation was detected that eroded in to the urethra. Coapitation of the bladder neck was near to normal and the bladder lumen was normal.

Surgical procedure

The patient underwent tape removal four months ago and this operation was terminated at this level because of the sever inflammation and adhesion.

At the second operation, urethra was reconstructed using martius flap. We create a urethral flap from anterior wall of the vagina and using Mathew technique over a urethral catheter, this flap added to the urethra. Then, by using incision of the lateral border of major labia, martius flap was separated and fixed over the neourethra using sub dermal tunnel.

The patient was continent three weeks after urethral catheter removal.

Edited by: Mohammad Hossein Soltani - Farshad Zohrabi

(Jul -2011)