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Transvaginal BNC Effective for Devastated Urethra

Early results show use of posterior urethral flap for bladder neck closure is safe and effective

TUESDAY, July 5 (HealthDay News) -- Modified transvaginal bladder neck closure (TV BNC) with a urethral flap is effective for devastated urethra, minimizing the risk of upper tract injury and fistula formation, according to a study published in the July issue of Urology.

Eric S. Rovner, M.D., from the Medical University of South Carolina in Charleston, and colleagues reviewed TV BNC procedures performed on 11 patients with nonfunctional or destroyed urethra due to chronic urethral catheterization. The patients had an average age of 52.7 years and were treated at the same institution over a period of three years. The urinary reconstruction involved the use of a posterior urethral flap and suprapubic tube placement. A cystogram was done two to three weeks after surgery, and patients were followed up for an average of 9.6 months.

The investigators found that postoperative failure was experienced by one patient at six weeks. No intraoperative or postoperative complications developed, but two patients required postoperative blood transfusions. None of the patients required readmission to the hospital, and cystograms three weeks following surgery showed no fistula development in any of the patients. The average follow-up of patients was done at 9.6 months. No recent onset hydroureteronephrosis was observed during imaging at the last follow-up.

"We believe that the use of the urethra as a flap maintains the BNC safely away from the ureteral orifices, decreasing the risk of upper tract injury. The rotation of the posterior urethra onto the anterior bladder wall secures the suture line high into the retropubic space, minimizing the risk of fistula formation," the authors write.

Abstract
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