Vaginal Free Graft Dorsal Onlay Urethroplasty

Female urethral stricture is a rare, but often underrecognized, cause of voiding dysfunction in females.¹ Vaginal free graft urethroplasty has been shown to have good efficacy and durability in treating urethral stricture, though accessible descriptions of technique are not widely available.^1,2 Accordingly, we set out to describe and demonstrate our technique for vaginal mucosal free graft dorsal onlay urethroplasty.

A fifty-one year old female with long-standing history of voiding dysfunction and incomplete emptying presented to our urology clinic, and was diagnosed with urethral stricture. Following evaluation to ensure adequate vaginal mucosal tissue, treatment with vaginal graft urethroplasty was offered. Tenets for success in performing vaginal free graft urethroplasty include adequate dorsal urethral dissection and mobilization, incision of entire length of stricture, removal of underlying fibromuscular tissue from graft, and tension-free anastomosis of graft to urethra. Appropriate selection of vaginal graft harvest site is key to avoid excessive narrowing of the vagina.

In this patient, vaginal free graft urethroplasty provided a successful and durable treatment of her urethral stricture. Vaginal free graft urethroplasty is an approachable and reproducible technique for treating urethral stricture in a female, while avoiding the morbidity associated with buccal graft harvest.

This video provides a step-by-step description of technique for performing vaginal free graft dorsal onlay urethroplasty to treat urethral stricture in a female.