Vaginal flap urethroplasty for wide female stricture disease

As in men, female urethral stricture disease is often treated with repeat urethral dilation or internal urethrotomy but not always with good results. In nonresponsive cases surgical treatment may be useful but only a few cases are reported in the literature. We present our single institution experience with urethral reconstruction in 6 patients using an alternative vaginal inlay flap technique inspired by the Orandi technique.

We treated 6 women with urethral stricture. In 5 patients stricture involved the entire middle and distal urethra, and in 1 it also involved the proximal urethra with bilateral hydronephrosis. Patients underwent urethral reconstruction using a vaginal flap with a lateral vascular pedicle that maintains the vascular axis. The flap was partially de-epithelialized to favor tissue cicatrix formation where the sutures are placed and avoid fistula formation.

Mean followup was 70.8 months. Normal micturition was achieved after catheter removal in all patients. Post-void residual urine was measured postoperatively in 3 patients. One patient had significant post-void residual urine and required intermittent self-catheterization. The remaining 5 patients required no additional treatment.

Using the vaginal wall to reconstruct large segments of the female urethra is simple and appears to have good results. Our technique preserves the vascular axis of the flap and protects the sutures. More contributions to the existing literature are needed before any further conclusions can be drawn.