“…Labial grafts were used in three studies also showed similar results [13][14][15]. To avoid the potential risk of vaginal donor site morbidity and other demerits, several authors have started using the buccal mucosal graft (BMG) instead [24][25][26][27][28][29]. The success rate has been reported as slightly higher (94%) compared to the vaginal graft series (80%) [3].…”
Background
Bladder outlet obstruction (BOO) is an uncommon entity in women. The incidence is only 2.7–8% of women referred for voiding symptoms. It is common to treat female urethral strictures by repeated urethral dilatations with subsequent self-intermittent catheterisation, which often leads to stricture recurrence. We aim to review the technique and outcomes of Dorsal vaginal graft Urethroplasty (DVGU) to manage urethral strictures in females.
Methods
This study is a retrospective chart review of 24 women with urethral stricture who underwent dorsal vaginal graft urethroplasty by a single surgeon. Patients were selected based on history, physical examination, uroflowmetry, urethral calibration, urethroscopy and voiding cystourethrography. We compared the pre- and postoperative values of variables such as the peak flow (Qmax), post-void residual (PVR) and self-reporting satisfaction score.
Results
Mean (range) age of the patients was 46.54 (38–55) years. The mean PVR was 6.35 ml/s and 148.12 ml/s, respectively. The mean Qmax before and after surgery was 6.35–25.12 ml/s, respectively (p < 0.05). The mean PVR decreased from 148.12 ml (preoperative) to 41.67 ml (postoperative) (p < 0.05). Before and after surgery, the mean calibration size was 12.76 F and 24.50 F, respectively (p < 0.05). Self-reported satisfaction score (Patient Global impression of improvement) showed that five (5) patients scored 1 (very much better), sixteen (16) patients scored 2 (much better) and three (3) patients scored 3 (a little better). Three women (12.5%) had stricture recurrence. Two of them got stabilised with initial soft dilatation, and the third women required continued self-catheterisation. Overall, the success rate was 87.5% with a mean (range) follow-up of 22.62 (12–36) months.
Conclusion
Dorsal onlay vaginal graft urethroplasty is a simple, safe and practical approach to treat female urethral stricture with a reasonable success rate. It can be considered as a first-line option for definitive repair.
“…Labial grafts were used in three studies also showed similar results [13][14][15]. To avoid the potential risk of vaginal donor site morbidity and other demerits, several authors have started using the buccal mucosal graft (BMG) instead [24][25][26][27][28][29]. The success rate has been reported as slightly higher (94%) compared to the vaginal graft series (80%) [3].…”
Background
Bladder outlet obstruction (BOO) is an uncommon entity in women. The incidence is only 2.7–8% of women referred for voiding symptoms. It is common to treat female urethral strictures by repeated urethral dilatations with subsequent self-intermittent catheterisation, which often leads to stricture recurrence. We aim to review the technique and outcomes of Dorsal vaginal graft Urethroplasty (DVGU) to manage urethral strictures in females.
Methods
This study is a retrospective chart review of 24 women with urethral stricture who underwent dorsal vaginal graft urethroplasty by a single surgeon. Patients were selected based on history, physical examination, uroflowmetry, urethral calibration, urethroscopy and voiding cystourethrography. We compared the pre- and postoperative values of variables such as the peak flow (Qmax), post-void residual (PVR) and self-reporting satisfaction score.
Results
Mean (range) age of the patients was 46.54 (38–55) years. The mean PVR was 6.35 ml/s and 148.12 ml/s, respectively. The mean Qmax before and after surgery was 6.35–25.12 ml/s, respectively (p < 0.05). The mean PVR decreased from 148.12 ml (preoperative) to 41.67 ml (postoperative) (p < 0.05). Before and after surgery, the mean calibration size was 12.76 F and 24.50 F, respectively (p < 0.05). Self-reported satisfaction score (Patient Global impression of improvement) showed that five (5) patients scored 1 (very much better), sixteen (16) patients scored 2 (much better) and three (3) patients scored 3 (a little better). Three women (12.5%) had stricture recurrence. Two of them got stabilised with initial soft dilatation, and the third women required continued self-catheterisation. Overall, the success rate was 87.5% with a mean (range) follow-up of 22.62 (12–36) months.
Conclusion
Dorsal onlay vaginal graft urethroplasty is a simple, safe and practical approach to treat female urethral stricture with a reasonable success rate. It can be considered as a first-line option for definitive repair.
“…The possibility of incontinence due to sphincteric injury and sexual dysfunction due to injury of the cavernosal neurovascular bundles are the major disadvantages of the dorsal approach. [20][21][22] The most important reason for preferring the ventral approach in the present study was to protect the sphincter and thus avoid urinary incontinence. No SUI or urethra-vaginal fistula developed in our patients.…”
“…Of note, as reported by Mittal et al and Gomez et al, if the stricture is in the mid- or proximal portion of the urethra, the meatus can be spared, and a dorsal slit can be performed at the area of stricture. 52 , 58 Figure 19 Dorsal Buccal Mucosal Graft Urethroplasty. (i) Periurethral incision and mobilization of the urethra.…”
Section: Treatment Of Female Urethral Stricturementioning
Female urethral strictures are rare, but underdiagnosed pathologies that can cause voiding dysfunction. These strictures are best managed with open reconstruction, as endoscopic treatments have high rates of failure. A flap urethroplasty can be performed with vaginal, labial or bladder tissue. Meanwhile, graft urethroplasties can utilize vaginal, labial, buccal or lingual tissue. It is important to consider the etiology and type of stricture, local vascularity, and prior attempts at repair when selecting the type of repair. Multiple different techniques have been described with theoretical advantages to each one. While some studies have reviewed a few of the reconstructive techniques to treat female urethral strictures, no single study has accounted for each individual technique. In this review, we discuss techniques captured by a number of systematic reviews and other articles. We will herein focus on reviewing and describing each unique technique of reconstruction in the setting of female urethral stricture.
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