Introduction: The presence of the urethral meatus inside the vaginal cavity immediately below the vaginal vestibule (urethral ectopia or hypospadia) is the main cause of postcoital cystitis. Surgical treatment is the most effective option in such patients, but conventional intervention developed by O'Donnell R.P. has some potential drawbacks. High rate of suture dehiscence and recurrence of disease make this surgical method unpopular. In order to improve the results of surgical treatment we have modified classic method of urethral transposition.
Methods: from 2005 to 2019 in our clinic we have observed 412 female patients with localization of external urethral orifice in vagina and recurrent postcoital cystitis. 32 (7.8%) females underwent conventional distal urethroplasty according to O’Donnell technique and in 380 (92.2%) we’ve performed modified extravaginal transposition of urethra (B.K. Komyakov technique patent ?2408296 since 10.01.2011). There are some features of modified method. At first, urethra should be mobilized almost all long. Secondly, replacement of urethra occurs through submucosal tunnel in vaginal vestibule wall. Thirdly, the new place of external urethral orifice should be as close as possible to the clitoris. The wound on the old place of urethral orifice should be sutured in the longitudinal direction.
Results: Thirteen (3.1%) patients experienced suture dehiscence, back up displacement of urethra and recurrence of pathological condition. Five of them were operated using conventional technique. From all 32 patients, treated by O’Donnell intervention satisfactory results were achieved in 23 (71.9%), unsatisfactory – in 9 (28.1%). In women, who underwent new modified transposition of distal urethra, satisfactory results were reached in 385 (93.4%) and relapses were in 11 (26.6%) patients (?<0.05).
Conclusions: our technique of extravaginal urethral transposition compared with conventional operation enable to increase the reliability of urethra binding and decrease morbidity of intervention and risk of recurrence of disease. Source of
