Vaginal flap urethroplasty for female urethral stricture disease

Abstract

Aims: Urethral stricture disease in females is uncommon and is often treated with repeat dilation or internal urethrotomies. Various surgical techniques requiring tissue transfer or grafting to repair strictures have been described with successful results. The vaginal inlay flap is simple and easy to learn. In this follow-up report of the use of this flap with additional patients more complications with urge symptoms and difficulties with catheterization are reported.

Methods: Twelve symptomatic women with a history of traumatic or difficult catheterization, a history of at least 1 urethral dilation or urethrotomy and difficult or a failed attempt at catheter placement underwent urethroplasty. The technique consisted of incising the posterior aspect of the stricture and advancing a vaginal inlay flap. A retrospective chart review was performed.

Results: Follow-up was 3 months to 9 years. All patients had subjective relief of most of their symptoms and were able to catheterize with a 14Fr catheter. One patient underwent repeat dilation 3 weeks after the primary procedure with no recurrence and another woman required a cystoscopy and catheter insertion in the OR fifty-eight months post operatively. No patient had stress urinary incontinence. Irritative symptoms, particularly urge, and difficulties with catheterization persisted in some patients post operatively despite having a technically good repair.

Conclusion: Urethral stricture disease in females is an uncommon entity that can cause voiding symptoms, recurrent infections, retention and renal impairment. This method of surgical repair offers a durable result with a low incidence of complications.