A 61 year old woman presented for consultation for labial bulge status post cystourethrectomy for high grade muscle invasive bladder cancer. She has noted left labial swelling over the past several years, which has worsened with time and become increasingly uncomfortable. Upon exam a 5 cm peri-clitoral bulge herniating through the left labia minora is appreciated. It is easily reducible, but recurs readily. MRI imaging reveals a fat containing left labial hernia.

Patient was counseled, informed consent obtained, and patient brought to the operating room for vaginal hernia repair.

Midline vaginal incision was made. Tissue was significantly scarred and adherent. An enterocele was dissected off the vaginal epithelium. The left labial hernia was dissected and excised. An 8x10cm piece of Polyform mesh was cut to size and secured to ischiopubic rami and perivaginal connective tissues. Further coverage was provided with bilateral Martius flaps. Redundant left labial tissue was excised, improving cosmesis, concluding the procedure. See associated video for further description.

Vaginal repair with synthetic mesh and Martius flaps is a viable option for post-cystectomy labial hernia.