Rectus abdominis vaginoplasty after anterior exenteration for urologic malignancy

J. Kellogg Parsons, Anthony Tufaro, Bernard Chang, Mark P. Schoenberg

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Introduction. Vaginal resection is occasionally required in female patients who undergo anterior exenteration for invasive lower urinary tract malignancy. We have used a rectus abdominis myocutaneous flap to reconstruct the vagina and perineum after extensive local resection of bladder and urethral carcinoma. Technical Considerations. Either a left or right rectus flap is used. Once anterior exenteration, partial vaginectomy, and urinary diversion are completed, the median infraumbilical incision is extended superiorly to form an elliptical skin paddle centered over the superior half of the muscle. The superior epigastric vessels are ligated, the cephalad end of the muscle is divided at the level of the costal margin, and the flap is progressively elevated out of the rectus sheath by sequentially dividing the lateral perforating nerves and vessels. As the muscle is elevated, the inferior epigastric pedicle is carefully preserved and followed inferiorly to its origin from the external iliac artery. Once a length of muscle sufficient for it to reach the perineum is mobilized, the flap is carried transpelvically. For complete vaginal reconstruction, the flap may be inverted into a tube, with the cephalic portion anchored to the perineum. Alternatively, the skin paddle may be used to fill tissue defects in the vagina and pelvic floor. The anterior abdominal wall fascia and skin edges at the donor site are closed primarily. We have successfully applied this technique in 4 patients who underwent anterior exenteration for invasive bladder and urethral carcinoma. Conclusions. Rectus abdominis vaginoplasty is a viable surgical option for reconstruction after anterior exenteration with vaginal resection for invasive cancer of the bladder and urethra.

Original languageEnglish (US)
Pages (from-to)1249-1252
Number of pages4
JournalUrology
Volume61
Issue number6
DOIs
StatePublished - Jun 1 2003
Externally publishedYes

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Rectus Abdominis
Perineum
Muscles
Vagina
Skin
Neoplasms
Urethral Neoplasms
Urinary Bladder
Carcinoma
Urinary Diversion
Myocutaneous Flap
Pelvic Floor
Iliac Artery
Fascia
Abdominal Wall
Urinary Tract
Urinary Bladder Neoplasms
Head
Tissue Donors

ASJC Scopus subject areas

  • Urology

Cite this

Rectus abdominis vaginoplasty after anterior exenteration for urologic malignancy. / Parsons, J. Kellogg; Tufaro, Anthony; Chang, Bernard; Schoenberg, Mark P.

In: Urology, Vol. 61, No. 6, 01.06.2003, p. 1249-1252.

Research output: Contribution to journalArticle

Parsons, J. Kellogg ; Tufaro, Anthony ; Chang, Bernard ; Schoenberg, Mark P. / Rectus abdominis vaginoplasty after anterior exenteration for urologic malignancy. In: Urology. 2003 ; Vol. 61, No. 6. pp. 1249-1252.
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abstract = "Introduction. Vaginal resection is occasionally required in female patients who undergo anterior exenteration for invasive lower urinary tract malignancy. We have used a rectus abdominis myocutaneous flap to reconstruct the vagina and perineum after extensive local resection of bladder and urethral carcinoma. Technical Considerations. Either a left or right rectus flap is used. Once anterior exenteration, partial vaginectomy, and urinary diversion are completed, the median infraumbilical incision is extended superiorly to form an elliptical skin paddle centered over the superior half of the muscle. The superior epigastric vessels are ligated, the cephalad end of the muscle is divided at the level of the costal margin, and the flap is progressively elevated out of the rectus sheath by sequentially dividing the lateral perforating nerves and vessels. As the muscle is elevated, the inferior epigastric pedicle is carefully preserved and followed inferiorly to its origin from the external iliac artery. Once a length of muscle sufficient for it to reach the perineum is mobilized, the flap is carried transpelvically. For complete vaginal reconstruction, the flap may be inverted into a tube, with the cephalic portion anchored to the perineum. Alternatively, the skin paddle may be used to fill tissue defects in the vagina and pelvic floor. The anterior abdominal wall fascia and skin edges at the donor site are closed primarily. We have successfully applied this technique in 4 patients who underwent anterior exenteration for invasive bladder and urethral carcinoma. Conclusions. Rectus abdominis vaginoplasty is a viable surgical option for reconstruction after anterior exenteration with vaginal resection for invasive cancer of the bladder and urethra.",
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