Vaginal flap urethroplasty for female urethral stricture disease

Gormley, E. Ann

doi:10.1002/nau.20814

Cited by 54 publications

(55 citation statements)

References 8 publications

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“…The three other patients who had SUI preoperatively had no complaints of SUI postoperatively. That fi nding combined with the ≈ 50% success rate for concomitant pubovaginal sling placement reported by Gormley [ 11 ] will continue to engender discussion on whether to perform a suburethral sling at the time of urethroplasty in the patient with combined urethral stricture disease and SUI. We did not note consistently robust urinary fl ow rates postoperatively even among our most successful cases.…”

Section: Discussionmentioning

confidence: 92%

“…This incongruence suggests that clinical thought may have not progressed signifi cantly since the 1930s when Folsom and Alexander [ 8 ] stated: ' Any pain within 2 feet of the urethra which does not seem to be adequately accounted for by some defi nite pathology should be suspected of being due to the urethra ' . Although the exact aetiology at this time is unclear many have felt that urethral stricture may be related to infection, chronic irritation, prior dilatation, diffi cult catheterisation, urethral surgery and trauma [ 9,10,11 ] . The trauma has been described as either obstetrical, blunt pelvic trauma, as well as repeated vigorous coitus [ 5 ] .…”

Section: Discussionmentioning

confidence: 99%

“…Successful cure for female urethral stricture disease has been described with minimally invasive corrective therapy, e.g. urethral dilatation and self-intermittent catheterisation, with surgery being advocated for patients who have failed these tactics [ 9,11,14 ] . Many women not undergoing surgery but treated with chronic interval urethral dilatations and internal urethrotomies will have high recurrences and may result in increased scarring and fi brosis [ 7,15 ] .…”

Section: Discussionmentioning

confidence: 99%

“…This was used in the past as well Powell and Powell [ 10 ] reporting a 20 F calibre threshold for diagnosis in 1949. This somewhat generous calibre for diagnosis has been further reduced with Gormley [ 11 ] reporting ≈ 12 F and Weinberg et al . [ 24 ] using a 16 F value for diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…In all, 10 of the women we treated did not need to perform routine postoperative daily clean intermittent catheterisation as part of their treatment plan as described in other series [ 11 ] . The one patient who has continued on self-intermittent catheterisation (although her PVRs were not markedly elevated), still felt that the operation did have a measure of success but desired to continuing this practice three times a week for peace of mind.…”

Section: Discussionmentioning

confidence: 99%

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Dorsal vaginal graft urethroplasty for female urethral stricture disease

et al. 2012

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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.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Dorsal vaginal graft urethroplasty for female urethral stricture disease

et al. 2012

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Vestibular flap urethroplasty in women with recurrent distal intramural urethral pathology

Romman

Takacs

Gilleran

2014

Neurourol. Urodynam.

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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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Vaginal flap urethroplasty for female urethral stricture disease

Abstract: Urethral stricture disease in females is an uncommon entity that can cause voiding symptoms, recurrent infections, retention and renal impairment. This method of surgical repair offers a durable result with a low incidence of complications.

Cited by 54 publications

References 8 publications

Dorsal vaginal graft urethroplasty for female urethral stricture disease

Dorsal vaginal graft urethroplasty for female urethral stricture disease

Vestibular flap urethroplasty in women with recurrent distal intramural urethral pathology

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

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