Dr. Reed, How common is a urethral vaginal fistula and how would you propose management? Karen
The underside of the urethra is the pathway that leads to the pelvic space which is retro-prostatic and retro-vesical. That is behind the prostate and bladder. It is possible that during development of the space the urethra may be entered or it could occur during aggressive dilation or penetrating sex. Involvement of the bladder has to be excluded.
If the opening is small, hopefully with catheterization it may close spontaneously. If the opening is larger and longer the sides of the urethra have to be undermined so they drop down like drapes and the edges closed. A buccal graft (taken from the inside of the cheek) may be required. The patient should plan on wearing a catheter for 3 to 4 weeks.
Vaginal packing will be inserted after surgery, but is removed in one week and there is a possibility that the vaginal space may close from lack of dilatation. Rule, number one is to re-establish normal sit-to-void urination
Harold M. Reed, M.D.
The Reed Centre for Transgender Surgery – Miami