Ventral-inlay buccal mucosal graft urethroplasty for female urethral stricture

Nayak, Prasant; Mandal, Swarnendu; Das, Manoj Kumar

doi:10.4103/iju.iju_57_19

Cited by 21 publications

(14 citation statements)

References 27 publications

(83 reference statements)

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“…9 Finally, among 12 women who underwent ventral-onlay buccal mucosal graft urethroplasty, AUA-SI improved a mean of 16.5 points (27.8 preoperatively to 11.3 postoperatively) over a mean follow-up of 18 months. 10 The postoperative symptom scores reported in our study are similar to those in the published literature. This suggests that regardless of surgical approach, urethroplasty for female urethral stricture disease results in significant improvement in urinary symptoms.…”

Section: Lane Et Alsupporting

confidence: 89%

“…Symptoms relevant to urethral stricture disease such as incomplete emptying, intermittency, weak stream, stranguria, frequency, urgency, and nocturia are assessed by the AUA-SI. Score severity is classified as mild (0-7), moderate (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19), or severe (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). Data were collected as aggregate scores.…”

Section: Methodsmentioning

confidence: 99%

“…Prior small, single-institution, case series describing patient reported outcome measures (PROMs) after reconstructive urethroplasty show that women report significant improvement in voiding symptoms after treatment of urethral stricture. [7][8][9][10] To date, only one small study has reported on patient Quality of life (QOL) after female urethroplasty. 11 Furthermore, there is a lack of data comparing PROMs between surgical repair techniques or between those with treatment success or failure.…”

Section: Introductionmentioning

confidence: 99%

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Changes in patient reported outcome measures after treatment for female urethral stricture

Lane

Gracely

Uberoi

et al. 2021

Neurourology and Urodynamics

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Introduction: There is a paucity of patient reported outcome measure (PROM) data for women with urethral strictures. To address this gap, we aim to evaluate change in PROM among women who underwent surgery for a stricture. Methods: American Urological Association Symptom Index (AUA-SI) and Urogenital Distress Inventory (UDI-6) data from a multi-institutional retrospective cohort study of women treated for urethral stricture was assessed.Results: Fifty-seven women had either AUA-SS or UDI-6 and 26 had baseline and postoperative data for either. Most women underwent urethroplasty (77%) and the majority (73%) remained stricture free at median follow-up of 21 months (interquartile range [IQR] 7-37). The median baseline AUA-SI was 21 (IQR 12-28) and follow-up was 10 (IQR 5-24). After treatment, there was a median decrease of 12 (IQR −18 to −2) in AUA-SI (p = 0.003). The median AUA Quality of life (QOL) score at baseline and follow-up were 6 (IQR 4-6) and 3 (IQR 2-5), respectively. There was a median AUA-QOL improvement of 2 points (−5,0; p = 0.007) from a baseline 5 (unhappy) to 3 (mixed). Median UDI-6 scores were 50 (IQR 33-75) at baseline and 17 (IQR 0-39), at follow-up.After treatment, there was a median decrease of 19 (−31 to −11; p = 0.01). Conclusion: Women with urethral strictures have severe lower urinary tract symptoms which improved after surgery. This study substantiates the claims that recognizing and treating women with urethral stricture disease greatly improves lower urinary tract symptoms and QOL. K E Y W O R D Sfemale urogenital diseases, patient reported outcome measures, retrospective studies, treatment outcome, urethra, urethral stricture Giulia Lane and Alyssa Gracely contributed equally to the study.

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Section: Lane Et Alsupporting

confidence: 89%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Changes in patient reported outcome measures after treatment for female urethral stricture

Lane

Gracely

Uberoi

et al. 2021

Neurourology and Urodynamics

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“… 22 Given that this procedure is performed intraurethrally, Nayak et al describes this technique as a true “inlay” and remarks that all other female urethroplasties that have been described have been “onlays”. 22 …”

Section: Treatment Of Female Urethral Stricturementioning

confidence: 99%

“…For the dorsal approach, advantages include: 1) increased vasculature and support, which can aid in healing, 2) allowing for a urethral meatus that will be directed upward to avoid an inward urinary stream facing the vagina, and 3) avoidance of anterior vaginal wall manipulation, which can hinder a future anti-incontinence procedure. 4,14,[22][23][24] Disadvantages include 1) increased blood loss given increased vasculature near the clitoris, 2) injury to the clitoris or neurovascular bundle which can lead to sexual dysfunction, and 3) increased risk of incontinence as there is risk to injuring supporting pubourethral ligaments and the dorsal muscular fibers of the external urethral sphincter. 4,14,[22][23][24] The converse is true of the ventral approach.…”

Section: Dorsal Vs Ventral Approachmentioning

confidence: 99%

Treatment of Urethral Stricture Disease in Women: Nonsystematic Review of Surgical Techniques and Intraoperative Considerations

Chua¹,

Mikhail²,

Patel³

et al. 2021

RRU

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Female urethral strictures are rare, but underdiagnosed pathologies that can cause voiding dysfunction. These strictures are best managed with open reconstruction, as endoscopic treatments have high rates of failure. A flap urethroplasty can be performed with vaginal, labial or bladder tissue. Meanwhile, graft urethroplasties can utilize vaginal, labial, buccal or lingual tissue. It is important to consider the etiology and type of stricture, local vascularity, and prior attempts at repair when selecting the type of repair. Multiple different techniques have been described with theoretical advantages to each one. While some studies have reviewed a few of the reconstructive techniques to treat female urethral strictures, no single study has accounted for each individual technique. In this review, we discuss techniques captured by a number of systematic reviews and other articles. We will herein focus on reviewing and describing each unique technique of reconstruction in the setting of female urethral stricture.

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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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Ventral-inlay buccal mucosal graft urethroplasty for female urethral stricture

Cited by 21 publications

References 27 publications

Changes in patient reported outcome measures after treatment for female urethral stricture

Changes in patient reported outcome measures after treatment for female urethral stricture

Treatment of Urethral Stricture Disease in Women: Nonsystematic Review of Surgical Techniques and Intraoperative Considerations

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

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