ABSTRACT

Background:

The tethered vagina syndrome is an iatrogenic condition caused by scar-induced tightness in the bladder neck area of the vagina. The classical symptom is commencement of uncontrolled urine leakage as soon as the patient’s foot touches the floor on getting out of bed in the morning. With this condition, the bladder works like a watering can, due to loss of elasticity in the bladder neck area. This situation is somewhat similar to “motor detrusor instability”, and so is considered as being incurable. 1990 Petros described a new strategy for treatment. The first step is to free ali scar tissue from urethra and bladder neck, the second to increase the tissue in the bladder neck area of vagina, thereby restoring elasticity. Aim: To test the efficacy and safety of three procedures which aim to restore elasticity in the bladder neck area of vagina.

Methods:

Between Jan. 2001 and Dec. 2009 we performed a plastic operation in the bladder neck area of vagina, “I-plasty” in 13 patients, a free skin graft in 21 patients, and a bulbo-cavernosus muscle-fat-skin-flap-operation from the labium majus in 85 patients.

Results:

At 6 month review, the cure rate (Urine loss <10 gm during 24 hours) for I-plasty was 3/13 (23%), for the skin graft, 11/21 (52%) and for the bulbocavernosus-flap, 68/85 (80%). The mean operating time was 62 minutes (range 41 - 98 min). Exclusively, a tethered vagina repair was performed in 5 patients, and in 114 cases, an entero/rectocoele repair was performed at the same time. Blood loss was minimal. The mean hospital stay was 5 days (range 2-9 days). Ali patients were mobile at least 4 hours after the operation. Three patients could not pass urine after extraction of the catheter one day after the operation, and in another, an indwelling catheter was necessary for 1 day.

Conclusion:

The bulbocavernosus-fat-skin-flap is the most effective way to cure severe incontinence caused by scarring due to previous vaginal or bladder neck surgery.