Dorsal buccal graft urethroplasty in female urethral stricture disease: a multi-center experience

Hampson, Lindsay A.; Myers, Jeremy B.; Vanni, Alex J.; Virasoro, Ramón; Smith, Thomas G.; Capiel, Leandro; Chandrapal, Jason; Voelzke, Bryan B.

doi:10.21037/tau.2019.03.02

Cited by 34 publications

(44 citation statements)

References 24 publications

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Section: Resultsmentioning

confidence: 99%

“…Although a working definition of FUS is available, 2 absolute values of quantitative parameters are still undecided. Owing to a lack of consensus on the urethral calibration, authors used a range from <10 F, 17 <12 F, 21 <13 F, 24,34 <14 F, 8,[10][11][12][13]18,30 <17 F, 14,20,27,29 <18 F 23 to <19 F. 5,15,33 Devoid of a single definitive calibration value, most authors resorted to the radiological definition of a stricture as "distal urethral narrowing and proximal ballooning in the absence of other extramural or intramural cause." Table 1 summarizes the confirmatory and supportive tests for the diagnosis of FUS.…”

Section: Definitions Diagnostic Modalities and Etiologymentioning

confidence: 99%

“…Half of all patients (276), underwent previous interventions in the form of UDs/urethrotomies (98.2%) or urethroplasty (1.8%). 5,6,8,[10][11][12][13][14]16,17,[20][21][22]27,33,34 3.2 | Treatment of urethral stricture disease…”

Section: Definitions Diagnostic Modalities and Etiologymentioning

confidence: 99%

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Deciphering the enigma of female urethral strictures: A systematic review and meta‐analysis of management modalities

Sarin

Narain

Panwar

et al. 2020

Neurourology and Urodynamics

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Objective: To evaluate the management methods of female urethral stricture (FUS) and analyze the outcomes of surgical treatments. A meta-analysis was done in an attempt to identify the best approach of urethroplasty and the graft-of-choice. Materials and Methods: A systematic search of Pubmed/Medline and Embase databases was performed according to the Preferred Reporting Items For Systematic Review And Meta-Analysis statement, for articles reporting on FUS management in the last decade. The Newcastle-Ottawa scale was used to assess the quality of 28 included non-randomized studies. The data on FUS management was summarized and pooled success rates (taken as symptom improvement and no need for further instrumentation) were compared. The secondary outcome was to establish a diagnostic modality of choice and define a "successful-outcome" of repair. Results: The outcome was separately reported for 554 women undergoing surgical intervention for FUS in the literature. The criteria defining FUS were varied. A combination of tests was used for diagnosis as none was singularly conclusive. A total of 301 patients had previous urethral instrumentations. The pooled success rate of urethral dilatation (234 women) was 49% at a mean follow-up of 32 months; flap urethroplasty (108 cases) was 92% at a mean followup of 42 months; buccal mucosal graft (BMG) urethroplasty (133 cases) was 89% at a mean follow-up of 19 months; vaginal graft augmentation (44 cases) was 87% at a mean follow-up of 15 months; and labial graft reconstruction (19 cases) was 89% at a mean follow-up of 18.4 months. The dorsal approach of graft augmentation met with 88% (95% confidence interval [CI] 0.79-0.95) success compared with 95% (95% CI 0.86-1) for the ventral approach. Conclusion: FUS is a rare condition requiring a meticulous diagnostic workup using multiple tests. All urethroplasties have shown better pooled success rates (86%-93%) compared with dilatation (49%). BMG is equally effective as vaginal graft urethroplasty.

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Section: Resultsmentioning

confidence: 99%

Section: Definitions Diagnostic Modalities and Etiologymentioning

confidence: 99%

See 1 more Smart Citation

Deciphering the enigma of female urethral strictures: A systematic review and meta‐analysis of management modalities

Sarin

Narain

Panwar

et al. 2020

Neurourology and Urodynamics

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“…However, it is challenging to compare our results directly with this prior study, since only one patient in the cited series had primary urethral stricture 8 . Rates of outcomes for UFG are variable in the literature, ranging from 77% to 100% in series of between 1–39 patients 9 . Pooled success among all 77 patients reported in the literature was 83% 9 .…”

Section: Discussionmentioning

confidence: 81%

Treatment of urethral stricture disease in women: A multi‐institutional collaborative project from the SUFU research network

Lane

Smith

Stambakio

et al. 2020

Neurourology and Urodynamics

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Female urethral stricture disease is rare and has several surgical approaches including endoscopic dilations (ENDO), urethroplasty with local vaginal tissue flap (ULT) or urethroplasty with free graft (UFG). This study aims to describe the contemporary management of female urethral stricture disease and to evaluate the outcomes of these three surgical approaches. Methods: This is a multi-institutional, retrospective cohort study evaluating operative treatment for female urethral stricture. Surgeries were grouped into three categories: ENDO, ULT, and UFG. Time from surgery to stricture recurrence by surgery type was analyzed using a Kaplan-Meier time to event analysis. To adjust for confounders, a Cox proportional hazard model was fit for time to stricture recurrence. Results: Two-hundred and ten patients met the inclusion criteria across 23 sites. Overall, 64% (n = 115/180) of women remained recurrence free at median follow-up of 14.6 months (IQR, 3-37). In unadjusted analysis, recurrence-free rates differed between surgery categories with 68% ENDO, 77% UFG and 83% ULT patients being recurrence free at 12 months. In the Cox model, recurrence rates also differed between surgery categories; women undergoing ULT and UFG having had 66% and 49% less risk of recurrence, respectively, compared to those undergoing ENDO. When comparing ULT to UFG directly, there was no significant difference of recurrence. Conclusion: This retrospective multi-institutional study of female urethral stricture demonstrates that patients undergoing endoscopic management have a higher risk of recurrence compared to those undergoing either urethroplasty with local flap or free graft.

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“…Labial grafts were used in three studies also showed similar results [13][14][15]. To avoid the potential risk of vaginal donor site morbidity and other demerits, several authors have started using the buccal mucosal graft (BMG) instead [24][25][26][27][28][29]. The success rate has been reported as slightly higher (94%) compared to the vaginal graft series (80%) [3].…”

Section: Discussionmentioning

confidence: 94%

Dorsal vaginal graft urethroplasty in female urethral stricture: a contemporary series

Chakraborty

Vyas

2021

Afr J Urol

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Background Bladder outlet obstruction (BOO) is an uncommon entity in women. The incidence is only 2.7–8% of women referred for voiding symptoms. It is common to treat female urethral strictures by repeated urethral dilatations with subsequent self-intermittent catheterisation, which often leads to stricture recurrence. We aim to review the technique and outcomes of Dorsal vaginal graft Urethroplasty (DVGU) to manage urethral strictures in females. Methods This study is a retrospective chart review of 24 women with urethral stricture who underwent dorsal vaginal graft urethroplasty by a single surgeon. Patients were selected based on history, physical examination, uroflowmetry, urethral calibration, urethroscopy and voiding cystourethrography. We compared the pre- and postoperative values of variables such as the peak flow (Qmax), post-void residual (PVR) and self-reporting satisfaction score. Results Mean (range) age of the patients was 46.54 (38–55) years. The mean PVR was 6.35 ml/s and 148.12 ml/s, respectively. The mean Qmax before and after surgery was 6.35–25.12 ml/s, respectively (p < 0.05). The mean PVR decreased from 148.12 ml (preoperative) to 41.67 ml (postoperative) (p < 0.05). Before and after surgery, the mean calibration size was 12.76 F and 24.50 F, respectively (p < 0.05). Self-reported satisfaction score (Patient Global impression of improvement) showed that five (5) patients scored 1 (very much better), sixteen (16) patients scored 2 (much better) and three (3) patients scored 3 (a little better). Three women (12.5%) had stricture recurrence. Two of them got stabilised with initial soft dilatation, and the third women required continued self-catheterisation. Overall, the success rate was 87.5% with a mean (range) follow-up of 22.62 (12–36) months. Conclusion Dorsal onlay vaginal graft urethroplasty is a simple, safe and practical approach to treat female urethral stricture with a reasonable success rate. It can be considered as a first-line option for definitive repair.

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Dorsal buccal graft urethroplasty in female urethral stricture disease: a multi-center experience

Cited by 34 publications

References 24 publications

Deciphering the enigma of female urethral strictures: A systematic review and meta‐analysis of management modalities

Deciphering the enigma of female urethral strictures: A systematic review and meta‐analysis of management modalities

Treatment of urethral stricture disease in women: A multi‐institutional collaborative project from the SUFU research network

Dorsal vaginal graft urethroplasty in female urethral stricture: a contemporary series

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