Vaginal flap for urethral neomeatus reconstruction after radical surgery for vulvar cancer: A retrospective cohort analysis

Introduction Partial urethrectomy during radical surgery for vulvar cancer may help avoid adjuvant radiotherapy in some patients. This study aimed to evaluate surgical, oncologic, and urinary outcomes of a new surgical technique based on vaginal flap to perform neomeatus reconstruction after distal urethral resection in radical surgery for vulvar cancer. Methods Retrospective cohort study between January 2005 and December 2017. We recorded data on pre-and post-operative urinary symptoms, surgical procedures, complications, adjuvant therapy, and follow-up of all patients who underwent surgery for vulvar cancer and had distal urethral resection and neomeatus reconstruction with the proposed technique. The reconstruction was based on the development of a vaginal flap in which a circular opening was created to become the neo-outlet of the urethra. Results Of a total of 200 patients with vulvar cancer operated with curative intent, 33 (16.5%) underwent distal urethral resection and neomeatus reconstruction during surgery (median age 73 (range 57-89) years; median body mass index 25.3 (range 16.3-36.4) kg/m 2). Urethrectomy allowed the avoidance of adjuvant radiotherapy in 15/33 (45.5%) patients. No case of dehiscence was reported at the site of neomeatus. After a median follow-up of 39 (range 14-151) months, only one case of deviated urinary stream (3%) and no cases of neomeatus stricture were reported. Six (18.2%) patients developed or worsened urinary incontinence after urethral resection and neomeatus reconstruction, and there was no difference in the prevalence of urethral compressor muscle involvement during urethrectomy (p=0.19) and adjuvant radiotherapy (p=1.00). No recurrences were reported at urethral margins. Conclusions Distal urethral resection and neomeatus reconstruction seem to be associated with adequate healing and low complication rates, such as dehiscence, stenosis, and flux deviation/dribbling. New-onset or worsened urinary incontinence does not seem to be associated with urethral compressor muscle involvement during urethral resection or adjuvant radiotherapy.