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Background: The pubic region lies at the lower end of the abdomen who most inferior extent is the mons pubis. The well known mons pubis is the rounded mass of fatty tissue that lies directly over the joint of the pubic bone. This is more pronounced in women than men. In women it externally forms the anterior vulva which divides into the labia major that runs on each side of the pudendal cleft.

One of the structures within the vulval vestibule is the urethra. As an exit for urine it is easy to see that changes in the shape of the mons pubis, enlargement or sagging, could potentially alter the urinary flow from it. An overly large mons pubis could cause urinary obstruction because the vestibule gets filled with mons tissue. A sagging mons pubis, particularly after large amounts of weight loss could develop urinary obstruction due to the collapse of tissue above it which causes a direct urinary outflow obstruction.

Case Study: This female had a prior history of a large amount of weight loss and a circumferential tummy tuck and arm lifts. Despite the elimination of the abdominal overhang a heavy mons remained with frequent urinary tract infections.

Under general anesthesia the mons area was treated by small cannula liposuction combined with a pubic lift. The pubic lift was performed by removing a horizontal segment of skin and fat on the inferior aspect of previous tummy tuck scar.

Her mons shows a good improvement in its shape with decreased projection. Since surgery (6 months) she has not any recurrence of her urinary tract infections.

A heavy and overhanging mons can be a mechanical source of obstruction for urinary outflow. This case demonstrates the successful resolution of the urinary tract infections by mons pubis reshaping.

Case Highlights:

1) A sagging mons pubis can be a source of urinary stream obstruction.

2) A pubic lift with mons defatting by liposuction can improve its shape as well as decrease or eliminate urinary stream obstruction.

3) A pubic lift is really a reverse mini-tummy tuck which can be done remotely (waistline) or directly.

Dr. Barry Eppley

Indianapolis, Indiana

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