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.
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