AUTHOR=Ceccaroni Marcello , Ferrari Filippo Alberto , Roviglione Giovanni , Bruni Francesco , Mantovani Giulia , Bogani Giorgio , Cristofoli Cesare , Masini Gaia , Maggiore Umberto Leone Roberti 

TITLE=Vaginal “tunnel flap” technique for urethral neomeatus reconstruction after distal urethrectomy in advanced vulvar cancer: a case report with anatomical insights

JOURNAL=Frontiers in Medicine

VOLUME=Volume 12 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2025.1695521

DOI=10.3389/fmed.2025.1695521

ISSN=2296-858X

ABSTRACT=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 report, 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.