Does successful urethral calibration rule out significant female urethral stenosis? confronting the confounder- an outcome analysis of successfully treated female urethral strictures

Abstract

Objective: The diagnosis and treatment of female urethral stricture disease (FUSD) are practiced variably due to the scarcity of data on evaluation, variable defi nitions, and lack of long-term surgical outcomes. FUSD is diffi cult to rule out solely on the basis of a successful calibration with 14F catheter. In this study, we have tried to characterize the variable clinical presentation of FUSD, the diagnostic utility of calibration, videourodynamic study(VUDS), and urethroscopy in planning surgical management. Materials and Methods: A retrospective review of records of 16 patients who underwent surgical management of FUSD was analyzed. The clinical history, examination fi ndings, and the results of all the investigations (including urofl owmetry, VUDS fi ndings, urethroscopy) they underwent, the procedures they had undergone ,and the follow-up data were studied. Results: A total of 16 patients underwent surgical management of FUSD. 13 out of 16 patients had successful calibration with 14F catheter on the initial presentation. These 13 patients on VUDS demonstrated signifi cant BOO and had variable stigmata of stricture on urethroscopy. The mean IPSS, fl ow rate, and PVR at presentation and after urethroplasty were 23.88±4.95, 7.72±4.25mL/s, 117.06±74.46mL and 3.50±3.44, 22.34±4.80mL/s, and 12.50±8.50mL, respectively. (p <0.05). The mean fl ow rate after endo dilation(17F) (n=12) was 11.4±2.5mL/s while after urethroplasty improved to 20.30±4.19mL/s and was statistically signifi cant(p <0.05). Conclusions: An adept correlation between clinical assessment, urethroscopy fi ndings, and VUDS is key in objectively identifying FUSD and planning surgical management. A good caliber of the urethra is not suffi cient enough to rule out a signifi cant obstruction due to FUSD. Early urethroplasty provides signifi cantly better outcomes in patients who have failed dilation as a treatment.

Update on female urethral reconstruction

“…In the postradiation scenario, the quality of local tissues is significantly compromised, as it may be also the bladder function [3]. Although in our report the two operated patients failed and required a diversion [2], Kalra et al reported on 3 patients managed with a DBMG with immediate success, however, no detailed follow-up was given [5]. Caution is advised with these cases and the recommendation is to maximize conservative approach with dilations or endoscopic procedures, reserving reconstruction for carefully selected cases.…”

“…However, calibration alone may be misleading, since Kalra et al confirmed recently with video-urodynamic studies that a successful 14F calibration was unreliable to rule out obstructive stricture. [5]. Radiologically, FUS has been defined as a ‘distal narrowing and proximal urethral ballooning in the absence of other extramural or intramural causes’ [4 ▪▪ ].…”

“…FUS is not frequent, accounting for 4–13% of women presenting with bladder outflow obstruction, which in general translates to about 0.1–1% of all women having check-ups for refractory lower urinary tract symptoms (LUTS) [2,3,4 ▪▪ ,6 ▪ ,7–10]. There is an increased incidence in women over 65 years [6 ▪ ] and there is often a significant delay in the diagnosis of FUS from the onset of symptoms, with a mean reported delay of 4–5 years [2,5].…”

“…Urethral pain, terminal dribble, and hematuria are infrequent [4 && ,7]. Presentation with renal failure and bilateral hydronephrosis is of historical interest and very rare, but still present in modern series [1,2,5,8].…”