PURPOSE: Complete urethral reconstruction in women is an extreme challenge for urologists. We report a new approach to this challenging procedure, using a modified neurovascular pudendal thigh flap (Singapore flap) for neo-urethral reconstruction in two patients at our institution.
MATERIALS AND METHODS: A Singapore flap was raised and transposed to the vagina in two patients with destroyed urethras following several previous uro-gynecologic procedures. In one case, the flap was tubularized distally and anastomosed proximally to the bladder neck. In the second case, the flap served to cover a urethroplasty inlay.
RESULTS: We are presently reporting mainly on the surgical technique. At 24 and 27 months respectively, the two flaps are viable and appear to fulfill their designated roles. The first case developed bladder neck stricture 2 months after surgery, and urethral dilation was performed successfully. Urinary incontinence still remains an issue in one of these two patients, and further continence procedures have been used.
CONCLUSIONS: It has been found that the neurovascular pudendal thigh flap, initially described for vaginal reconstruction, is an attractive technique to aid in complete female neo-urethral reconstruction. Further follow-up of patients is necessary to address the issue of continence.