Urological assistance during therapeutic pubectomy

Purpose: A technique is described to optimize exposure during female pubectomy to minimize injury to associated urological structures. Materials and Methods: Three females with diagnosed osteomyelitis pubis underwent pubectomy. Before resection of the bone, the patients underwent a formal combined transvaginal and retropubic dissection. This dissection allowed complete freeing of the urethra and bladder from areas of orthopedic resection and optimized surgical exposure. Results: All operations were completed successfully with no incidence of intraoperative urological structure injury and no postoperative pelvic instability. None of the patients required intraoperative or postoperative blood transfusions. Pelvic pain resolved in all 3 patients. Conclusions: Using a combined transvaginal and retropubic technique, the urologist may assist the orthopedic surgeon at the time of pubectomy. This technique potentially minimizes the incidence of vesical and urethral injury.