Female urethral reconstruction: dorsal buccal mucosa graft onlay

Abstract

Purpose: Female urethral stricture (FUS) is an infrequent entity, but may cause significant morbidity. Despite a rising interest in recent years, there is still scarce published information. In this article, we review FUS with a special attention to the use of dorsal buccal mucosa grafts (DBMG).

Methods: A literature search was conducted summarizing information about etiology, anatomy, diagnosis, and management. A detailed description of our technique for DBMG urethroplasty is given, with a summary report of our experience and results.

Results: FUS accounts for about 1% of all women consulting for lower urinary tract symptoms (LUTS). Diagnosis is suspected in front of persistent LUTS suggestive of obstruction. Confirmatory tests are uroflowmetry, endoscopy, and urethrography; true anatomic strictures must be differentiated from functional or physiological obstructions. Initial management may include dilations, but recurrence is frequent. On the contrary, reconstructive surgery is highly efficient, with overall curative rates around 90%. For reconstruction, DBMG has gained popularity, because it would maintain intact the ventro-lateral urethral supporting structures, important for continence. The pathology of female strictures is unknown and neither the pre nor the intraoperative assessment allows determining the precise location and extent or the urethral damage; therefore, we advise extensive grafting of the entire urethra. Collected success of DBMG is 86% at a mean follow-up of 21 months. Morbidity is very low and de novo stress incontinence has not been reported.

Conclusions: Because of its many advantages, DMBG currently represents a prime choice for FUS reconstruction.

Keywords: Buccal mucosal graft; Dorsal urethral onlay; Female urethral stricture; Female urethroplasty; Reconstructive urology.