Techniques and results of urethroplasty for female urethral strictures: our experience with 17 patients

Abstract

Objectives: To report our experience with urethroplasty in women with urethral stricture and discuss the therapeutic considerations and outcomes of various flap- and graft-based techniques.

Methods: A total of 17 patients with mid to distal urethral stricture (urethral caliber <14F, maximal urinary flow rate <12 mL/s, and detrusor pressure >20 cm H(2)O during voiding) underwent urethroplasty from 2004 to 2010. Of the 17 patients, 7 had undergone previous instrumentation and 10 were repaired primarily. The preoperative workup included American Urological Association symptom score assessment, uroflowmetry, voiding cystourethrography, and urethrocystoscopy. Of the 17 patients, 10 received anterior vaginal wall mucosa inlay urethroplasty. Proximally, the dilated urethral mucosa was used in 1 patient. A Martius flap reinforced ventral buccal mucosa graft (BMG) onlay urethroplasty was used in 2 patients with previous synthetic midurethral slings. Two patients with an atrophic vagina received a dorsal BMG onlay. A circular BMG reconstruction was used in 2 patients with severe distal urethral stricture. The preoperative findings were compared with the postoperative data at the last follow-up using the Wilcoxon sign test.

Results: With a median follow-up of 24 months (range 6-78), an objective and subjective cure was achieved in 17 (100%) and 15 (88%) patients, respectively. At the last follow-up, the mean maximal urinary flow rate increased from 10.8 ± 3.2 mL/s preoperatively to 28.9 ± 7.4 mL/s (P = .001), and the mean postvoid residual urine volume had decreased from 120 ± 30 mL preoperatively to 30 ± 12 mL (P = .001). The mean American Urological Association score had decreased from 27.1 ± 3.9 preoperatively to 7.1 ± 3.5 postoperatively (P < .0001).

Conclusions: Primary urethroplasty can be considered a first-line option for treatment of female urethral strictures. Local mucosal flaps will cure the problem in most situations. BMG offers an excellent alternative when viable local tissue is absent.