Dorsal vaginal graft urethroplasty for female urethral stricture disease

Study Type--Therapy (case series) Level of Evidence 4. What'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.

• To review the technique and outcomes of using a dorsal vaginal graft to perform urethroplasty for the treatment of urethral strictures in women.

• 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.

• 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).

• 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.