A Complex Reconstructive Approach to Iatrogenic Vaginal Scarring and Resultant Urethral Intercourse.

Introduction and hypothesis: This video aims to: 1) Review vaginal septa; 2) Present a case of iatrogenic vaginal scarring leading to unknowing engagement in urethral intercourse; and 3) Demonstrate a multi-component reconstructive procedure to restore vaginal patency and urethral continence.

Methods: This is a stepwise demonstration of surgical techniques with video narration. IRB approval was not required.

Results: Vaginal septa are congenital anomalies that may present as transverse, longitudinal, and oblique septa Miller et al (Clin Obstet Gynecol 51:223-36, 1); Skinner and Quint (J Minim Invasive Gynecol 24: 909-14, 2). Concomitant anal, renal, or ureteral anatomic differences may be present, and additional imaging should be considered Lecka-Ambroziak et al (J Clin Med 12:7284, 3); Murphy et al (Curr Opin Obstet Gynecol 35: 328-36, 4); Kang et al (Medicine (Baltimore) 97:e12822, 5). This video presents the case of a 20-year-old female with a history of a vaginal septum resection followed by multiple surgeries resulting in a bladder injury and vaginal scarring. Subsequently, she developed chronic urinary leakage and dyspareunia. Examination revealed a urethra splayed from the meatus to the bladder trigone and vaginal obliteration. This video details an extensive reconstructive procedure, emphasizing the use of an autologous sling, Martius flap, and biologic graft. Ultimately, successful genitourinary reconstruction restored this patient's sexual function and urinary continence.

Conclusions: Accurate diagnosis of congenital anomalies and referral to appropriate care are essential to ensure positive outcomes. Urogynecologists are well-equipped to perform these multi-component procedures.