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Abstract
Introduction/Background Vulvar cancer represents less than 1% of all malignant tumors in women, predominantly affecting elderly women. Over a third of patients will experience recurrence within the first 5 years, making therapeutic intervention a surgical challenge that often requires a multidisciplinary approach.
Methodology We present the case of an 84-year-old patient, ECOG 0, diagnosed in 2017 with stage IB squamous cell carcinoma of the vulva (FIGO 2009), treated with radical vulvectomy, with no sentinel lymph node detected. During follow-up, the patient experienced up to five recurrences treated with radiotherapy and exenterative and reconstructive surgery. In 2022, a new local recurrence of 4 cm at the periurethral level resulted in urethral stenosis associated with severe urinary incontinence due to sphincter infiltration. A radical en bloc resection of the lesion, including the urethra up to the bladder neck and two-thirds of the external vagina, was performed vaginally, with superior vaginal and bladder neck closure and clear margins. In a second step, through a suprapubic transverse incision, an extraperitoneal dissection of the bladder was performed, creating a vesical flap with an angled subcutaneous trajectory that exited through a Mitrofanoff-type skin opening to establish continence, reducing the risk of intestinal complications associated with the classic technique using the appendix or ileum. Due to the lack of tension in the vulvar suture, no flap was performed.
Results The patient was discharged on the ninth postoperative day, with a post-surgical complication of a urinary tract infection successfully treated with ciprofloxacin.
Conclusion This case illustrates an effective and less morbid solution in the treatment of recurrent vulvar cancer with urological involvement, emphasizing the relevance of a multidisciplinary approach in complicated cases to improve both survival and the quality of life of patients.
Disclosures I declare I have no relevant nor material financial interests that relate to the research described in this paper.
