HIGH POSTTRAUMATIC VAGINAL STRICTURE COMBINED WITH URETHROVAGINAL FISTULA AND URETHRAL STRICTURE IN GIRLS - RECONSTRUCTION USING A POSTERIOR SAGITTAL PARARECTAL APPROACH

Purpose: High vaginal stricture is a rare abnormality of traumatic ori gin, which in most cases is associated with urethral injury. Because t o our knowledge there are no previous reports of surgical management o f this condition, we describe our experience with plastic surgery perf ormed via a posterior sagittal: approach using local tissue in girls w ith posttraumatic vaginal stricture. Materials and Methods: We perform ed vaginoplasty using a posterior sagittal pararectal approach in 6 gi rls 5 to 14 years old with posttraumatic high vaginal stricture. Five patients had urethral stricture and urethrovaginal fistula. In 5 cases bladder neck closure and the Mitrofanoff procedure were done. Results : There were no complications in any patients during the immediate pos toperative period. Followup studies 1 to 3 years later in all girls re vealed a fully patent vaginal anastomosis. Conclusions: Principles of reconstruction that must be followed if a positive result is to be obt ained include concurrent vaginoplasty and suture of the urethrovaginal fistula with separation of the suture line, complete excision of scar s in the segments being joined, use of meeting flaps to lengthen the a nastomotic line as much as possible, and prevention of ischemia and in flammation in the anastomotic region.