Traumatic absence of the proximal urethra

Objective Traumatic absence of the proximal urethra is an obstetrical vesicovaginal fistula resulting from obstructed labors in Niger, Africa. Repair by direct reanastomosis was evaluated. Study design A prospective case series of 25 women with traumatic absence of the proximal urethra underwent a direct layered reanastomosis of the distal urethra to the urethrovesical junction. Results are based on 21 patients (84%) examined at follow-up. Results Seventeen patients (81%) had complete healing of their fistulas. After direct reanastomosis alone, 48% (10 of 21) were dry. An additional 7 patients (33%) suffered from urinary incontinence despite closure of their fistulas. Four patients (19%) had a persistent fistula. Conclusion Direct layered reanastomosis is an acceptable primary repair procedure for traumatic absence of the proximal urethras.