No abstract

Urethral stricture is a rare condition in women, representing a diagnostic challenge for the urologist. Its main etiology is traumatic or due to labor. Definitive treatment can be by means of dilations or urethroplasty using both local flaps and free grafts. In this study, we report the case of a patient with voiding symptoms during a period of 9 years after childbirth, despite an attempt of urethral dilation and chronic self-catheterization. The patient was finally diagnosed of a long distal urethral stricture, and she underwent urethroplasty with an anterior vaginal wall flap with satisfactory results. We take the opportunity to briefly review the diagnostic pathway in women with obstructive symptoms and the main female urethroplasty techniques.

Vesicovaginal fistulas (VVaFs) are relatively uncommon in developed countries but with devastating consequences for the women suffering them. Conservative management has a low response rate.The surgical repair is a technically demanding procedure. Transvaginal, open transabdominal or laparoscopic (pure or robot-assisted) approaches have been described with similar post-operative results. We report two real-life cases of VVaF after surgery of benign gynaecological conditions, both presenting with continuous urinary incontinence and repaired with laparoscopic surgery. The first case had a simple tract above the trigone and was managed with an extravesical approach. The second is a complex case with multiple fistulous tracts that required a transabdominal-transvesical approach (modified O'Connor technique). Both patients have their fistula closed and are continent after surgery with a mean follow-up of 9 months. Given the lack on evidence for the selection of the best approach, it is important to report the outcomes with the different surgical techniques in both simple and complex fistulae. A pre-operative exhaustive study of the location and number of fistulous tracts is essential, as well as selecting the technique which best allows tissue dissection and tension-free suture to get a successful closure. Therefore, knowledge of several procedures and approaches is mandatory when dealing with this disorder.