Female Urethroplasty: A Practical Guide Emphasizing Diagnosis and Surgical Treatment of Female Urethral Stricture Disease

Abstract

Female urethral strictures are rare. Guidelines on how to diagnose and treat these strictures are lacking. At present, only expert opinion is available to guide clinical practice. Once the diagnosis is suspected based on obstructive voiding symptoms and uroflowmetry, most clinicians will use in addition video-urodynamics (including urethrography), urethral calibration and cystourethroscopy for confirmation of the diagnosis. Clinical inspection and gynaecological examination are also important. Urethral dilation is usually the first-line treatment despite the lack of long-term success. Female urethroplasty is associated with higher success rates. A multitude of techniques are described but not one technique has shown superiority above another. This narrative review aims to provide a clinical guide for diagnosis and treatment to the urologist motivated to perform female urethroplasty.

Ventral onlay buccal mucosa graft urethroplasty for female urethral stricture

“…5 When strictures are suspected, depending on the voiding symptoms, clinicians often use uroflowmetry, videourodynamics, urethral calibration and cystoscopy. 11 In the present study, the diagnosis was based on clinical, urodynamic and urethrocystoscopic findings. Radiographic findings during VUD study show an open bladder neck with narrowing more distally within the urethra, and relaxation of the sphincter.…”

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

“…It is not uncommon for women to report pain with micturition along with urgency and frequency. The presence of urinary retention exposes affected patients to increased risk of urinary tract infections with or without incontinence [134,145,146]. Depending on the severity of disease rare cases reporting urinary retention leading to renal failure, hydronephrosis and pyelonephritis have been described secondary to urethral strictures [134,147,148].…”

“…[149]. A pelvic exam may reveal lichen stenosis, pelvic organ prolapse, meatal stenosis or periurethral abnormalities as the etiology of the patient's symptoms [145]. The inability to pass a 14 Fr urethral catheter has been accepted as nearly pathognomonic for the presence of a stricture despite no formal definition regarding the normal caliber of the female urethra [145].…”

“…No consensus management strategy currently exists for female urethral strictures and to a large degree surgical management plans often follow to the comfort and/or expertise of the surgeon in performing a particular procedure [145,146]. While more conservative management plans may utilize smaller caliber Clean Intermittent Catheterization (CIC) or indwelling urinary foleys the surgical management consists of dilation techniques, meatoplasty and/ or urethroplasty with or without usage of flaps or grafts [145,146,150].…”

“…A study evaluating the effectiveness of urethral dilation/ urethrotomy where within most women the urethra was dilated to between 30 Fr to 41 Fr reported a composite success rate of 47% with a 58% and 27% success rate respectively in cases of no previous dilation or previous dilations [149]. However, it was noted that following the procedures it was recommended that the patients perform daily CIC at least once and success rate pertained more towards the need for reoperation opposed to success rates defined more so by the absence of need to perform CIC and no need for further operations [145,151].…”