Dorsal vaginal graft urethroplasty for female urethral stricture disease

Abstract

Study Type – Therapy (case series)Level of Evidence 4What's known on the subject? and What does the study add?Female urethral stricture disease has been described for almost 200 years. The symptoms of female stricture disease may range from clinically insignificant to severe and debilitating with the exact aetiology being unclear. No strict criteria for diagnosis have been established with the diagnosis often relying on a combination of presenting symptoms and objective findings. Initial therapy for female urethral stricture disease has often rested on urethral dilatations and self‐intermittent catheterisation with surgery reserved for patients that failed conservative measures. Female urethroplasty currently is a topic of increasing attention with multiple surgical approaches described including use of both grafts (vaginal wall, buccal mucosal membrane, lingual mucosa, and labia minus) and flaps (vaginal vestibule, anterior vagina, and lateral vagina).We describe our approach to female urethroplasty using a suprameatal (dorsal) approach (described by Tsivian and Sidi) with an autologous vaginal epithelium inlay graft. The technique and modern approaches to female urethroplasty are contrasted and discussed. The success of the approach including continence rates and lack of need for long‐term self‐intermittent catheterisation is noted.OBJECTIVE To review the technique and outcomes of using a dorsal vaginal graft to perform urethroplasty for the treatment of urethral strictures in women. PATIENTS AND METHODS This is a retrospective chart review of 11 women who were treated with a dorsal vaginal graft urethroplasty by one surgeon. All women underwent preoperative evaluation that included history, physical examination, fluoro‐urodynamics and urethral calibration. After surgery interviews, physical examinations, and urinary flow and postvoid residual urine volumes (PVRs) were obtained. RESULTS In all, 11 women who had undergone dorsal vaginal graft urethroplasty were identified for review. The mean (range) age was 60.6 (39–75) years. The mean (range) follow‐up was 22.7 (6–46) months. There were no cases of new onset stress urinary incontinence. The mean PVRs before and after surgery were 187.1 mL and 75.8 mL, respectively (P= 0.003). The mean urinary flows before and after surgery were 7.3 mL/s and 21.8 mL/s, respectively (P= 0.001). No patient has required repeat surgery. Self‐reporting satisfaction scores using the Patient Global Impression of Improvement showed that four patients scored 1 (very much better), three scored 2 (much better), two patients scored 3 (a little better), and one scored 4 (no change). Only one patient scored a 5 (worse). CONCLUSION Dorsal graft urethroplasty with vaginal mucosa may be considered as a first‐line option for definitive management of female urethral stricture disease. No consensus exists for the surgical treatment of female urethral stricture disease.

Surgical management of female urethral strictures

“…Petrou et al . published the largest series employing the dorsal vaginal graft urethroplasty, based on Tsivian and Sidi’s technique (32). They published their experience in 11 patients, with three of the patients requiring subsequent urethral dilation within a follow-up range of 6–46 months (32).…”

Penile urethra replacement with autologous cell-seeded tubularized collagen matrices

“…In instances where local tissue is unavailable, other sources of donor tissues have been considered as alternative substitutes for urethral repair. These include genital and extragenital skin flaps, bladder and buccal mucosa, tunica vaginalis, bowel segments and temporary or biodegradable stents as alternative conduits for urethral substitution (Ahmad et al ., ; Tavakkoli Tabassi and Mohammadi Rana, ; Petrou et al ., ; Palminteri et al ., ; Schwentner et al ., ; Talja et al ., ). While the use of autologous tissue grafts has an advantage of being immune‐compatible, complications such as donor site morbidity continue to remain a problem (Xu et al ., ; Jang et al ., ).…”

Ventral‐onlay buccal mucosa graft substitution urethroplasty for urethral stricture in women

“…We have summarized the outcomes of all published female urethroplasty series in Table 2 [6,8,9,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]. The median number of urethroplasty cases in these papers was 8, ranging from 2 to 30 [8,26].…”

“…Female urethral stricture (FUS), although uncommon, has a large impact on quality of life, with urethral pain and recurrent infections causing much misery. BOO in women may be more common than previously believed, occurring in [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22].4% of women presenting with LUTS [1,2], with FUS causing BOO and LUTS in 0.32-4.9% of cases [3][4][5]. Traditionally FUS has been managed using endoscopic techniques with or without intermittent self-catheterization (ISC).…”