Urethral Reconstruction During Posterior Sagittal Anorectovagino-Urethroplasty / PSARVUP
Urethral Reconstruction
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Colorectal surgeons at Cincinnati Children's Hospital Medical Center provides information about urethral reconstruction in Posterior Sagittal Anorectovagino-Urethroplasty / PSARVUP.
In cases where vagina and urethra have been separated, once the vagina has been mobilized enough to perform a satisfactory reconstruction, the urethra is then reconstructed using the common channel.
Fortunately, most common channels have the necessary caliber for a normal urethra for that specific patient.
On rare occasions the surgeon may find either a very wide cloaca or a very narrow common channel that may be considered inadequate for a functional urethra.
The first situation has an advantage because the available tissue may be used to reconstruct the vagina and make a small urethra.
In the second situation, the patient may require a more complex type of plasty using part of the labia to make a wider urethra.
The urethra most frequently is reconstructed around the Foley catheter that was previously introduced into the bladder; for this, we use long-term absorbable 5-0 sutures which should not be under tension.
The urethra is reconstructed in two layers, particularly in the uppermost portion of the suture line which is the most common site for fistula formation.
The electrical stimulator allows the dectection of voluntary striated muscle in both sides of this common channel; this muscle may play an important role in urinary continence. Most patients with a normal sacrum will have normal urinary control after this type of reconstruction.
The urinary sphincter is not small, localized ring of muscle as has been described by others but is represented by a continuum of muscle that starts at the level of the levator and goes all the way down to the skin on both sides of the common channel (neo-urethra).
For more information or to request an appointment, please contact the Colorectal Center at Cincinnati Children's.
