Case Overview:
- 20-year-old female totally incontinent of urine and stool when referred in 1979
- Prior operations included colostomy, colon pullthrough, right nephrectomy, and a flap to enlarge the UGS opening
- She was in diapers
Follow Up:
At age 39 years
- In vitro fertilization was performed
- Two normal babies were born by caesarean section, a boy and a girl
- Thereafter, patient was completely incontinent of urine
- Endoscopy showed a large hole (10 cm from the urethral meatus just below the bladder neck)
- Passing the telescope through it visualized the cervix
At age 43 years
- Patient underwent a 16-hour operation done in prone position through a posterior sagittal approach
- Rectum and vagina were dissected completely; the urethra was opened to full length up to the fistula. The urethra was closed. A 2-inch 5.08 cm. wide and 17.78 cm. long flap of buttocks was used to cover the urethral closure
- Vagina and rectum were replaced with a perineal body between
- Patient received 7 units of packed red cells, 2 units of fresh frozen plasma, 11 liters of lactated Ringer’s solution, all equivalent to 3 blood volumes of fluid replacement
- Despite very careful positioning and padding, there was temporary quadriceps weakness post-op.
- With urinary continence and daily enema washout for her colon, the patient began to socialize and got married
At age 53 years
- Patient was doing well
THP Source: