Best Video Award: A Complex Reconstructive Approach to Vaginal Scarring and Urethral Intercourse

Objectives: This video aims to achieve the following objectives: 1) Provide an overview of vaginal septa; 2) Discuss a unique case involving a patient with a vaginal septum who developed iatrogenic vaginal scarring after undergoing three prior surgeries, leading to unknowing engagement in urethral intercourse; and 3) Present the steps of a multi-component reconstructive procedure that successfully restored vaginal patency and urethral continence.

Methods: This video reviews vaginal septum classifications and treatment strategies. It 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 significantly impacting her quality of life. Examination revealed a urethra splayed from the meatus to the bladder trigone and severe anteroposterior vaginal scarring causing 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.

Clinical Relevance: Accurate diagnosis of congenital anomalies and referral to appropriate care are essential in reducing surgical morbidity and ensuring positive outcomes. Urogynecologists, with their high-volume specialty training, are well-equipped to perform these multi-component procedures for patients.