Volar onlay urethroplasty for reconstruction of female urethra in recurrent stricture disease

Abstract

The World Health Organization has expanded the microscopic forms of urothelial carcinomas to include several unusual histological variants. The importance of the recognition of these unusual forms is related to: a) different prognosis; b) different therapeutic approach; and, c) the possibility of misinterpretation by the pathologist.An important example is the small cell carcinoma with neuroendocrine differentiation. The importance of an accurate diagnosis of this variant of urothelial carcinoma is its response to newer chemotherapy protocols. The histological variants of urothelial carcinoma includes: nested variant, urothelial carcinoma with small tubules, microcystic urothelial carcinoma, micropapillary variant, lymphepithelioma-like, sarcomatoid carcinoma (carcinosarcoma), small cell carcinoma, plasmacytoid carcinoma, urothelial carcinoma with rhabdoid features, urothelial carcinoma with clear cytoplasm (glycogen-rich), urothelial carcinoma with trophoblastic differentiation, urothelial carcinoma with unusual stromal reactions, osteoclast-rich undifferentiated carcinoma, and giant cell carcinoma (1).The study by Keck et al. based on a large series of plasmacytoid carcinoma showed that this tumor is an aggressive variant of bladder cancer with molecular features of advanced bladder cancer and evidence of WNT pathway activation in some of the cases. Dr. Athanase Billis Full-Professor of Pathology State University of Campinas, UnicampCampinas, São Paulo, Brazil E-mail: athanase@fcm.unicamp.br Objective: To report our experience with a new and simple method of urethral repair with a volar onlay of free labium minus graft. Strictures of the female urethra are rare, and it is well accepted that the therapeutic options of dilation and urethrotomy are not lasting solutions as a result of their high recurrence rates. However, there is no consensus regarding the best way to reconstruct the female urethra in the case of stricture disease. Patients and Methods: Four consecutive female patients with a long lasting history of recurrent urethral strictures underwent open urethroplasty with a volar situated free split thickness epidermal graft from the labium minus. The surgical technique is described and a short-term follow-up is presented. RECONSTRUCTIVE UROLOGY __________________________________________________doi