Circumferential excision with vaginal flap reconstruction and mucocutaneous anastomosis: a novel surgical technique for adult female urethral prolapse

Abstract

Urethral mucosal prolapse in adult women is an uncommon and often underdiagnosed condition presenting as circumferential eversion of the urethral mucosa through the external meatus. Existing surgical techniques vary in recurrence risk and cosmetic outcome, with no universally accepted approach. We describe the Circumferential Excision with Vaginal Flap Reconstruction and Mucocutaneous Anastomosis (CVMA) technique and present a prospective case series of ten adult women with confirmed urethral mucosal prolapse who underwent CVMA between August and November 2025 after failure of conservative therapy. Patients were followed at 1, 3 and 6 months. Results: The mean patient age was 42 years. Complete circumferential prolapse was confirmed in all cases, with redundant tissue ranging from 1.5 to 3 cm. Mean operative time was 45±10 minutes with no intraoperative complications. Transient urinary urgency was noted in 3 patients (30%) in the first postoperative month, resolving with conservative management. All patients reported satisfactory cosmetic outcomes with no recurrence at six months. CVMA is a safe and reproducible technique offering durable anatomical correction, periurethral reinforcement, and favourable cosmetic results. Larger prospective studies are warranted to validate these findings.