Multicentric evaluation of a lateral-based anterior vaginal wall flap for female urethral stricture repair

Female urethral stricture (FUS) is an uncommon pathology. Success of the different treatments has not been compared and the published series have low sample size and short follow-up, so the evidence is not enough to support one technique over another. Treatment options include urethral dilatation and urethroplasty. Urethroplasty techniques include vaginal flap and graft urethroplasty. The objective is to evaluate the efficacy and safety of the lateral-based anterior vaginal wall flap for the treatment of FUS, and to describe our experience in etiology, diagnosis and treatment.

A retrospective study for women treated with the referred technique at three University hospitals between 1999 and 2023. Surgery was considered successful when there was resolution of voiding symptoms, absence of recurrent urinary tract infections, absence of postvoid residual and >50% increase of peak urinary flow (Qmax). Subjective response was assessed with PGI-I questionnaire.

Twenty-four patients were included. The mean age was 53.5 years (31-82) and follow-up was 9.5 years (2-21.8). The long-term success rate was 95.8% (N.=23). Peak flow improved from 7.5 to 17.5 mL/s (P=0.001)) and post-void residual urine decreases from 65 to 9 mL (P=0.006). Four patients (16.6%) had Clavien-Dindo I complications and no long-term complications. No de novo urinary incontinence was observed. The main limitations are the retrospective design and the relatively low number of patients.

Treatment of female urethral stricture by lateral-based vaginal wall flap has proven to be safe, with high short- and long-term efficacy.