case_images: PMC10883186_01
case_images: Preoperative and postoperative pictures. (a) Lines of incision (b) Postoperative follow-up picture showing separate (-) urethral and (=) vaginal orifices
case_images: JIAPS-29-59-g001.jpg
case_images: PMC10883186_01_JIAPS-29-59-g001.jpg
case_images: jiaps.jiaps_135_23-f001
case_images: An inverted U-shaped incision was made anterior to the anus, UGS was cut back to few millimeters, followed by half circumferential incision around the UGS [Figures 1a and 2a]. At 6-month follow-up, she remains continent for bowel and bladder [Figure 1b].
case_images: Line diagram of surgical procedure. (a) Lines of incision in red color (b) Lateral view - showing the plane of dissection to reach vagina and opening of the vagina at most dependent area (c) separation of UG sinus through the vaginal end (d) Labial fat pad taken from the lateral side to interpose between the sutured ends (e) Lines of skin closure from the lateral and posterior flaps
case_images: JIAPS-29-59-g002.jpg
case_images: PMC10883186_01_JIAPS-29-59-g002.jpg
case_images: jiaps.jiaps_135_23-f002
case_images: An inverted U-shaped incision was made anterior to the anus, UGS was cut back to few millimeters, followed by half circumferential incision around the UGS [Figures 1a and 2a]. Once the dissection reached the vagina, identified by palpating the already placed Foley's bulb, the vaginal wall was opened at the most dependent position and vaginal mobilization was done with initial submucosal dissection to separate carefully from the confluence and the posterior wall of the urethra avoiding injury to the bladder neck region [Figure 2b]. Neo-urethra was reconstructed by securely closing the opening in the UGS [Figure 2c]. The right labial fat pad was developed inferiorly and interposed between the neo-urethral suture line and the mobilized vagina [Figure 2d]. Vaginal reconstruction was completed by raising perineal flaps and approximated to the end of the mobilized native vagina [Figure 2e].