Urethral stricture in women. Morphofunctional diagnosis and treatment

Abstract

Objectives: The objective of this article is to describe the diagnosis of bladder outlet obstruction in women and the treatment of urethral strictures as a cause of it.

Method: A bibliographic review was performed in the Medline (PubMed) data base on articles published on the diagnosis of bladder outlet obstruction in women and the treatment of urethral stricture in the period between 1989-2009.

Results: The prevalence of obstruction in women varies between 2.7% and 23% in the literature. Videourodynamic studies are the gold standard for diagnosis. 78% of obstructions are functional, and only 6.8% are secondary to urethral stricture. Strictures commonly affect urethral meatus and distal third of the urethra, the most frequent cause being yatrogenic, secondary to incontinence surgery, urethral dilations and traumatic catheterization. The treatment of urethral stricture will depend on the location and length of the stricture, length of the healthy proximal urethra, bladder neck integrity and coexistence of incontinence. The repeat failure of non-invasive techniques and the presence of partial or total urethral defects will be subsidiary to urethral reconstruction techniques by means of flaps or grafts, although the technique of choice is still controversial.

Conclusion: The diagnosis of bladder outlet obstruction in women is limited by the absence of clearly defined urodynamic parameters. Urethral stricture is an infrequent cause of obstruction, the treatment of which may constitute a therapeutic challenge. Early stricture relapse may constitute ground for considering early surgical reconstruction. Vaginal flaps are the cornerstone of urethral reconstructions. Extensive vulvar scarring may require the use of grafts.