Who does transposition help?
The diagnosis is made by the characteristic connection of exacerbations with sexual intercourse and examination: the external opening of the urethra is located at the very entrance to the vagina or moves into it when the labia are parted (O'Donnell-Hirschhorn test). The surgeon selects the distal part of the urethra by 1.5–2 cm, dissects the adhesions, forms a new opening 1–1.5 cm higher, closer to the clitoris, and fixes the urethra with sutures; the old hole is sutured. Catheter 2–3 days. Sexual activity resumes after 4–6 weeks; with the correct indications, exacerbations stop, sensitivity and urinary retention are not affected.
Two problems of the female urethra
Prolapse of the urethral mucosa - prolapse of the mucosa through the external opening in the form of a ring, more often in girls and women in menopause, with bleeding, pain and dysuria; if ointments are ineffective, excision is performed. Transposition of the urethra is indicated for postcoital cystitis - exacerbations after each sexual intercourse due to the low location or hypermobility of the external opening of the urethra at the entrance to the vagina: moving the opening higher eliminates the reflux of flora and repeated infections.
Results
After excision of the prolapse, symptoms disappear, relapses are rare. Transposition relieves postcoital cystitis in 80–90% of women with correctly established indications (confirmed connection of exacerbations with sexual intercourse, low opening or adhesions during examination). Both operations do not affect urinary continence or sensation.
