Female Urethral Strictures: Review of Diagnosis, Etiology, and Management

Agochukwu‐Mmonu, Nnenaya; Srirangapatanam, Sudarshan; Cohen, Andrew; Breyer, Benjamin N.

doi:10.1007/s11934-019-0933-1

Cited by 32 publications

(27 citation statements)

References 34 publications

(42 reference statements)

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“…Injury to the urethral epithelium may result in healing by scarring and subsequent formation of a stricture 3 . The patients may present with LUTS, recurrent urinary tract infections (UTIs), overflow incontinence of urine, urethral pain, and/or high postvoid residual urine (PVR) 4 …”

Section: Introductionmentioning

confidence: 99%

“…3 The patients may present with LUTS, recurrent urinary tract infections (UTIs), overflow incontinence of urine, urethral pain, and/or high postvoid residual urine (PVR). 4 Precise diagnosis of FUS demands a high index of suspicion because of its uncommon nature, nonspecific presentation, and absence of a standardized definition as well as diagnostic criteria. It is, therefore, imperative to perform a battery of tests as the diagnosis cannot be based reliably on just one modality of investigation.…”

Section: Introductionmentioning

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: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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“…Vaginal flap and buccal mucosal graft urethroplasty were more reported and used for female urethral reconstruction, while these techniques are more suitable for female urethral stricture and small urethral loss. For long urethral defect or proximal urethral injuries bladder wall flaps can be adopted for urethroplasty [ 7 – 9 ].The female urethral replacement is mainly accomplished by anterior bladder wall (Tanagho) tube or tubularization of vaginal mucosa [ 10 ]. Tanagho was first to bring up the technique of reconstructing bladder neck with tubular anterior bladder flap in 1981 [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Bladder neck reconstruction in girls’ pelvic fracture bladder neck avulsion and urethral rupture

Jin

Shu

et al. 2020

BMC Urol

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Background Girls’ pelvic fracture bladder neck avulsion and urethral rupture is rare however it causes great morbidity. The management is complex and not standard yet. We report our experience and a technique of bladder neck reconstruction with anterior bladder wall flap. Methods We retrospectively analysed data of 5 girls with pelvic fracture bladder neck avulsion and urethral rupture admitted to our institution from July 2017 to October 2019. They all came to our institution with a suprapubic tube. Patients’ trauma was all initially treated at other hospitals, 4 had suprapubic cystotomy and 1 had urethral realignment. One girl also had three other urethroplasties at other hospitals. We took pubectomy, posterior ureth roplasty and bladder neck reconstruction with anterior bladder wall flap in these 5 girls. Post-operative assessments included voiding cystourethrography, uroflowmetry and urethroscopy after urethral catheter removal. Verbal consent to participate was obtained from the parent or legal guardian of the children. Results Operation time ranged from 120 to 180 min. Follow-up time is 12 to 27 months. Uroflowmetry showed that maximum urine flow rate improved significantly. Cystourethrography indicated good continuity of the urethra. Two girls had urinary incontinence postoperatively but were continent 3 months later. One patient developed vesical-abdominal fistula and got repaired by surgery 6 months later. She was continent ever since. Other complications were not observed during the follow-up period. Conclusions Our method of bladder neck reconstruction using bladder flap as a patch is feasible and provides good continence, especially for those with serious bladder neck avulsion and urethral rupture caused by extensive trauma and those who had posttraumatic urethral distraction needed second repair.

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“…Urethral stricture in and of itself is most notably thought to be secondary to an iatrogenic or traumatic history often found in patients with a history of pelvic fracture, childbirth, prolonged catheterization or status-post repair for urethral diverticulum, incontinence, a fistula or even prior treatments for urethral stricture that may worsen symptoms [134,139]. In a recent study the most common causes of urethral stricture in females was found to be prior urethral instrumentation, traumatic catheterization and history of traumatic childbirth [140].…”

Section: Urethral Stricture Diseasementioning

confidence: 99%

Female Urethral Disease: A Contemporary Review of Presentation, Diagnosis and Current Management Strategies

Cope¹,

Anglin²,

Dryden³

et al. 2021

J Surg Open Access

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Background: Female urethral diseases are sparsely discussed within the literature when compared to urethral diseases affecting men. While, the male urethra is impacted more frequently secondary to the comparative increase in average length, presence of the prostate and considerations of carrying genetic material-disease process of the female urethra impose significant distress to affected patients and also potential for malignancy. The clinical presentation and management strategies often differs from the male counterpart and therefore it is important to consider disease processes of the female urethra unto their own right for evaluation and successful management. It is to that end this publication is put forth.

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Female Urethral Strictures: Review of Diagnosis, Etiology, and Management

Cited by 32 publications

References 34 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

Bladder neck reconstruction in girls’ pelvic fracture bladder neck avulsion and urethral rupture

Female Urethral Disease: A Contemporary Review of Presentation, Diagnosis and Current Management Strategies

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