High posttraumatic vaginal stricture combined with urethrovaginal fistula and urethral stricture in girls: reconstruction using a posterior sagittal pararectal approach.

Abstract

High vaginal stricture is a rare abnormality of traumatic origin, which in most cases is associated with urethral injury. Because to our knowledge there are no previous reports of surgical management of this condition, we describe our experience with plastic surgery performed via a posterior sagittal approach using local tissue in girls with posttraumatic vaginal stricture. We performed vaginoplasty using a posterior sagittal pararectal approach in 6 girls 5 to 14 years old with posttraumatic high vaginal stricture. Five patients had urethral stricture and urethrovaginal fistula. In 5 cases bladder neck closure and the Mitrofanoff procedure were done. There were no complications in any patients during the immediate postoperative period. Followup studies 1 to 3 years later in all girls revealed a fully patent vaginal anastomosis. Principles of reconstruction that must be followed if a positive result is to be obtained include concurrent vaginoplasty and suture of the urethrovaginal fistula with separation of the suture line, complete excision of scars in the segments being joined, use of meeting flaps to lengthen the anastomotic line as much as possible, and prevention of ischemia and inflammation in the anastomotic region.