Abstract
A 47-year-old woman with a 6-year history of vulvar pruritus was diagnosed with vulvar extramammary Paget's disease extending to the urethra, vaginal introitus, and anal canal. Cystoscopy showed irregular mucosa limited to several millimeters from the external urethral meatus. The tumor and distal urethra were resected en bloc with a negative frozen section margin, preserving the urethral sphincter. Reconstruction used bilateral pedicled gracilis myocutaneous flaps, with the residual urethral mucosa directly anastomosed to the flap. Postoperatively, spontaneous voiding was maintained without residual urine or incontinence. At 3 years and 5 months, continence persisted without urethral stenosis or local recurrence.