Female urethral stricture disease: advances in diagnosis, surgical management, and standardized outcome reporting

Despite increasing awareness, female urethral stricture (FUS) lacks standardization of definition, diagnostic criteria, and specific treatment algorithm. This review summarizes recent advances in diagnosis, treatment modalities, and surgical outcomes reporting.

The main challenges of diagnosing FUS are its nonspecific symptoms and overlapping differential diagnoses. Although a urethral caliber <14 French is commonly used, this threshold lacks diagnostic reliability. Emerging modalities, including translabial ultrasound, appear promising, but endoscopic confirmation remains essential. Urethroplasty has increasingly replaced urethral dilations in recurrent and primary FUS. Various graft materials demonstrate comparable short-term to mid-term success rates, though differences exist in donor-site morbidity, operative time, and anatomical suitability. Dorsal and ventral graft placements yield similar outcomes, with technique selection influenced mostly by stricture location and surgeon experience. Minimally invasive approaches emerge, including transurethral urethroplasties and drug-coated balloon dilation, expanding treatment options. Overall, heterogeneity in outcome measures hinders comparability across studies, underscoring the need for standardized definitions and validated PROMs to assess functional recovery.

Efforts should be made to achieve homogeneity in definitions of FUS, diagnostic and treatment algorithms, and postoperative follow-up protocols. Standardization of the outcome measures following FUS repair by integrating objective micturition parameters and validated PROMs is crucial.