20-Year-Old Female Patient Totally Incontinent (Hendren Patient Case)

Case Overview: 
  • 20-year-old female totally incontinent of urine and stool when referred in 1979
  • Prior operations included colostomy, colon pullthrough, right nephrectomy, and a flap to enlarge the UGS opening
  • She was in diapers


Follow Up: 

At age 39 years

  • In vitro fertilization was performed
  • Two normal babies were born by caesarean section, a boy and a girl
  • Thereafter, patient was completely incontinent of urine
  • Endoscopy showed a large hole (10 cm from the urethral meatus just below the bladder neck)
  • Passing the telescope through it visualized the cervix

At age 43 years

  • Patient underwent a 16-hour operation done in prone position through a posterior sagittal approach
  • Rectum and vagina were dissected completely; the urethra was opened to full length up to the fistula. The urethra was closed. A 2-inch 5.08 cm. wide and 17.78 cm. long flap of buttocks was used to cover the urethral closure
  • Vagina and rectum were replaced with a perineal body between
  • Patient received 7 units of packed red cells, 2 units of fresh frozen plasma, 11 liters of lactated Ringer’s solution, all equivalent to 3 blood volumes of fluid replacement
  • Despite very careful positioning and padding, there was temporary quadriceps weakness post-op. 
  • With urinary continence and daily enema washout for her colon, the patient began to socialize and got married

At age 53 years

  • Patient was doing well
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