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CASE REPORT article

Front. Med.

Sec. Obstetrics and Gynecology

Volume 12 - 2025 | doi: 10.3389/fmed.2025.1695521

This article is part of the Research TopicCutting-Edge Strategies in Screening, Prevention, and Treatment in Gynaecologic OncologyView all 30 articles

Vaginal "Tunnel Flap" technique for Urethral Neomeatus reconstruction after distal urethrectomy in advanced vulvar cancer: a case report with anatomical insights

Provisionally accepted
Marcello CeccaroniMarcello Ceccaroni1Filippo Alberto FerrariFilippo Alberto Ferrari1*Giovanni RoviglioneGiovanni Roviglione2Francesco BruniFrancesco Bruni2Giulia MantovaniGiulia Mantovani3Giorgio BoganiGiorgio Bogani4Cesare CristofoliCesare Cristofoli2Gaia MasiniGaia Masini2Umberto Leone Roberti MaggioreUmberto Leone Roberti Maggiore4
  • 1Sacro Cuore Don Calabria Hospital (IRCCS), Negrar, Italy
  • 2IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy
  • 3Universita degli Studi di Bologna, Bologna, Italy
  • 4Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

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Vulvar cancer with distal urethral involvement requires radical surgery that can severely impact urinary function and quality of life. Urethral neomeatus reconstruction therefore represents a critical yet underexplored challenge in gynecologic oncology. We report a novel vaginal "tunnel flap" technique designed to recreate a functional urethral outlet after radical vulvectomy and distal urethrectomy. The flap leverages detailed knowledge of the urethrovaginal septum and its vascular supply to create a well-vascularized mucosal tunnel that reproduces native urethral morphology while minimizing suture line tension and the risk of postoperative stenosis. In the presented case, despite early wound-healing complications, suprapubic urinary diversion enabled complete recovery. Long-term follow-up showed sustained oncologic control, excellent urinary function, preserved sexual activity, and satisfactory aesthetic results. This report highlights the role of precise surgical anatomy in optimizing reconstructive outcomes and proposes a reproducible technique that balances oncologic safety with functional and aesthetic preservation.

Keywords: vulvar cancer, urethral neomeatus reconstruction, vaginal tunnel flap, Urethrectomy, Surgery

Received: 29 Aug 2025; Accepted: 19 Sep 2025.

Copyright: © 2025 Ceccaroni, Ferrari, Roviglione, Bruni, Mantovani, Bogani, Cristofoli, Masini and Leone Roberti Maggiore. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Filippo Alberto Ferrari, ferrarifilippoalberto@gmail.com

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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