Mp56-04 the Presentation, Management and Outcome of Female Urethral Diverticulum Surgery – Different but Equally Effective Either Side of the Pond

Abstract

INTRODUCTION AND OBJECTIVE: Urethroplasty for female urethral stricture (FUS) is becoming increasingly popular however there is little to guide choice of technique as all series to date contain small numbers with limited follow-up. We report the medium to long-term outcomes of ventral-onlay buccal mucosa graft substitution urethroplasty (VOBMGSU) in treating FUS.METHODS: A retrospective review of a prospectively acquired database of 46 consecutive women (median age 51.5 years, range 31-71) with urethral stricture having VOBMGSU under the care of a single surgeon since June 2012 and a minimum follow up of 6 months (median 25 months, range 6-96). Data was analysed for stricture recurrence, change in median peak free flow rate (Qmax), median post-void residuals (PVR) and Patient Global Impression of Improvement (PGII) using a 7-point Likert scale where 1 [ very much better and 7 [ very much worse. Short and longer-term complications of surgery were noted. Persistent or de-novo lower urinary tract symptoms (LUTS) were investigated to delineate their cause e and this is detailed.Statistical analysis was performed with the Wilcoxon signed rank test, Students T Test and Mann-Whitney U Test. Statistical significance was taken as P<0.05.RESULTS: At last follow-up 42/46 (91.3%) of women were stricture free. Mean Qmax significantly improved from 5.7 ml/s (range 0-13) to 15.5 ml/s (range 4-38) (p < 0.05). Mean PVR significantly reduced from 147mls (range 0-609) to 24 mls (range 0-245) (p < 0.05). Short and longer-term complication rates were low. 4 patients had pre-existing stress urinary incontinence (SUI). 2/42 (4.7%) patients developed mild de novo SUI, which settled with conservative measures by 6 months post urethroplasty. Frequency persisted in 4/ 46 (8.7%) and was managed with intravesical Botox in 2 and Sacral Neuromodulation in 1. Stricture recurrence was managed by meatotomy in 1, meatal dilatation in 1 and redo-VOBMG urethroplasty in 1 with resolution of stricture. A further patient had their recurrent stricture managed with redo VOBMG but suffered a further recurrence which was managed with a meatotomy. Median PGII at 12 months post VOBMG urethroplasty was 1.5 (1-4) and this was maintained at 36 months post-surgery.CONCLUSIONS: Medium to long term results in the largest series of VOBMG female urethroplasty in the world to date are excellent with stricture free rates of 91.3%, median PGII of 1.5 and significantly improved Qmax and PVRs.