Minimally invasive surgical treatment of female hypospadias and urethral hypermobility complicated by postcoital dysuria

Introduction. Currently, a large number of different surgical methods have been developed for the treatment of postcoital dysuria caused by hypospadias and urethral hypermobility. However, the literature does not reflect clear criteria and indications for a particular treatment method. Various modifications of the traditional urethral transposition can be accompanied by traumatic injury to the abundantly innervated paraclittoral and paraurethral zones, which provokes sexual disorders, up to anorgasmia. The search continues for new, effective, but less invasive techniques compared to traditional surgical transposition.Purpose of the study. To assess the efficacy and safety of a combined technique: removal of urethra-hymenal adhesions along with a paraurethral injection of gel filler.Materials and methods. 83 patients with hypospadias and urethral hypermobility complicated by postcoital dysuria were treated since 2015. The age ranged from 17 to 40 years. Examination revealed urethro-hymenal adhesions of varying severity and positive O’Donnell-Hirschhorn test in all women. One patient had previously undergone urethral transposition with a temporary effect. All women underwent surgical treatment, which consisted of the urethro-hymenal adhesions removal and suburethral injection of hyaluronic acid-based filler. The bulking gel (1-2 ml) was injected in a fan-shaped manner paraurethrally in from the point at 6 o'clock of the conventional dial. Thus, a «gel pad» was created, which lifts the meatus and the distal urethra, limiting their mobility and traumatization during intercourse. No complications were observed. The postoperative examination was performed after 1, 6, 12 months.Results. An improvement in the quality of life was noted in 74 patients (89%) (UDI 6 and PISQ-12 questionnaires). The external urethral orifice was not displaced inwards, the urethra projected above the vaginal entrance during the vaginal examination and the O’Donnell-Hirschhorn test. In 13 (15.5%) patients, the biodegradation of the gel was accompanied by the return of symptoms of various degrees in different terms after the operation (from 8 to 13 months). 8 women required repeat injections of the filler; four patients needed 2 injections and 1 patient needed three injections. The repeated manipulations were performed under local anaesthesia. In 8 cases (9.6%), continued urination disorders were noted despite the termination of the dominance of postcoital dysuria, which required additional complex treatment. Improvement of sexual life was observed in 89% of all operated women according to the described technique. Urethral transposition was not required in any of the patients.Conclusions. The combined technique improves the treatment's results of female hypospadias and urethral hypermobility complicated by postcoital dysuria with minimal development risk of complications. The disadvantage is the natural bulking gel biodegradation, which may necessitate its reimplantation