Management of the incompetent urethra in the chronically debilitated female patient: an alternative to urethral closure

Wedderburn,; Adamson,

doi:10.1046/j.1464-410x.1999.00290.x

Cited by 2 publications

(1 citation statement)

References 6 publications

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“…The functional urethral closure with pubovaginal sling [ 12 ], tension-free vaginal tape (TVT) [ 13 ], or a modified endoscopic colposuspension where sutures are tied more closely than for patients with genuine stress incontinence [ 14 ], represent alternative proposals. Careful patient selection for the aforementioned surgical methods is necessary because females with a completely eroded bladder neck and proximal urethra are not candidates for this procedure.…”

Section: Discussionmentioning

confidence: 99%

Transvaginal closure of urinary bladder opening and Mitrofanoff technique in a neurologically impaired female with chronic indwelling catheter: a case presentation

et al. 2021

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Background Chronic catheterization remains the only attractive option in specific circumstances, especially in neurologically impaired patients. Complications produced by the indwelling catheters, like patulous urethra and bladder neck destruction, usually lead to severe incontinence and significant nursing difficulties. Here, we describe a rare case, a urinary bladder opening representing massive and extensive destruction of the urethra and bladder sphincter due to an indwelling catheter. Case presentation We present a 46-year-old paraplegic woman complaining of recurrent febrile urinary tract infections and severe urinary incontinence. She suffered from persistent malodorous urine and skin breakdowns from constant urine leakage. The vaginal examination revealed extensive destruction of the urethra and a 10 cm opening permitting the urinary bladder wall to prolapse into the vagina. The patient underwent a combined surgical approach; a transvaginal bladder closure with anterior colporrhaphy and a Mitrofanoff procedure to ensure a continent stoma for future clean intermittent self-catheterization (CISC). The patient is compliant with CISC and, remains continent twelve years after surgery. Conclusion This case demonstrates that in the era of CISC, there are still neurologically impaired females suffering from rare but critical adverse effects of indwelling catheters. The urethra and bladder neck erosion represent a demanding treatment assignment. The Mitrofanoff procedure for continent stoma and the transvaginal closure of urinary bladder opening produced a lifesaving potential treatment.

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Section: Discussionmentioning

confidence: 99%

Transvaginal closure of urinary bladder opening and Mitrofanoff technique in a neurologically impaired female with chronic indwelling catheter: a case presentation

et al. 2021

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Transvaginal closure of urethra and correction of uterovaginal prolapse in neurologically impaired patient with chronic indwelling catheter

2009

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We report the case of a 38-year-old neurologically impaired woman with continuous urinary incontinence as a result of a chronic indwelling catheter for neurogenic bladder. Long-term catheter resulted in dilatation of urethra and pressure necrosis of urethra, with subsequent incontinence despite the catheter. She also had a stage 3 uterovaginal prolapse. She underwent cystoscopy, closure of urethra and bladder neck by transvaginal route (Feneley procedure), insertion of a suprapubic catheter, sacrospinous fixation and posterior colporrhaphy with prolene mesh (Apogee). Vaginal hysterectomy was declined by the patient and her family. She remained dry at follow-up visit and is happy with the outcome.

show abstract

Management of the incompetent urethra in the chronically debilitated female patient: an alternative to urethral closure

Cited by 2 publications

References 6 publications

Transvaginal closure of urinary bladder opening and Mitrofanoff technique in a neurologically impaired female with chronic indwelling catheter: a case presentation

Transvaginal closure of urinary bladder opening and Mitrofanoff technique in a neurologically impaired female with chronic indwelling catheter: a case presentation

Transvaginal closure of urethra and correction of uterovaginal prolapse in neurologically impaired patient with chronic indwelling catheter

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