Female urethral stricture disease: a narrative review on diagnosis, surgical techniques and outcomes

Female urethral stricture (FUS) disease is a rare condition occurring in 4-20% of women with refractory LUTS due to bladder outflow obstruction (BOO). Due to the rarity of this condition, standardization of definition as well as diagnostic criteria and treatment outcomes are lacking. A non-systematic review was conducted exploring the available literature on PubMed and EMBASE databases to identify publications related to the management of FUS between January 2019 and June 2024. Overall, 22 studies were identified. Diagnostic work-up appeared heterogeneous among authors: uroflowmetry (UFM), post-voiding residual of urine (PVR), (video-) urodynamic study (UDS), voiding cystourethrogram (VCUG), urethral calibrations (UC) and urethrocystoscopy (UCS) are the mostly employed tests. Primary treatment consists of urethral dilatation (UD) or urethrotomy. A variety of different reconstructive techniques are currently available such as meatoplasty, flap urethroplasty and graft urethroplasty. Outcome measures varied widely among authors. Patient-reported outcomes (PROMs) were assessed, with a focus on sexual function (FSFI), symptoms and QoL (AUA-ss, IPSS, PGI-I, ICIQ-FLUTS, ICIQ-FLUTSsex, ICIQ-S, UDI, SF-36), demonstrating general improvement. Success rates reported in literature appear to fairly agree amongst authors, but the variability of outcome measures reduces the significance of comparisons between studies. Efforts should be put into pursuing a homogeneity of definitions and criteria. PROMs are promisingly being employed in post-surgical evaluation and should be integrated into standardized follow-up protocols.