Female urethral stricture: a contemporary series

Spilotros, Marco; Malde, Sachin; Solomon, Eskinder; Grewal, Manpreet Kaur; Mukhtar, Bashir; Pakzad, Mahreen; Hamid, Rizwan; Ockrim, Jeremy; Greenwell, Tamsin

doi:10.1007/s00345-016-1947-7

Cited by 43 publications

(42 citation statements)

References 15 publications

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“…Although a working definition of FUS is available, 2 absolute values of quantitative parameters are still undecided. Owing to a lack of consensus on the urethral calibration, authors used a range from <10 F, 17 <12 F, 21 <13 F, 24,34 <14 F, 8,10–13,18,30 <17 F, 14,20,27,29 <18 F 23 to <19 F 5,15,33 …”

Section: Resultsmentioning

confidence: 99%

Deciphering the enigma of female urethral strictures: A systematic review and meta‐analysis of management modalities

Sarin

Narain

Panwar

et al. 2020

Neurourology and Urodynamics

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Objective: To evaluate the management methods of female urethral stricture (FUS) and analyze the outcomes of surgical treatments. A meta-analysis was done in an attempt to identify the best approach of urethroplasty and the graft-of-choice. Materials and Methods: A systematic search of Pubmed/Medline and Embase databases was performed according to the Preferred Reporting Items For Systematic Review And Meta-Analysis statement, for articles reporting on FUS management in the last decade. The Newcastle-Ottawa scale was used to assess the quality of 28 included non-randomized studies. The data on FUS management was summarized and pooled success rates (taken as symptom improvement and no need for further instrumentation) were compared. The secondary outcome was to establish a diagnostic modality of choice and define a "successful-outcome" of repair. Results: The outcome was separately reported for 554 women undergoing surgical intervention for FUS in the literature. The criteria defining FUS were varied. A combination of tests was used for diagnosis as none was singularly conclusive. A total of 301 patients had previous urethral instrumentations. The pooled success rate of urethral dilatation (234 women) was 49% at a mean follow-up of 32 months; flap urethroplasty (108 cases) was 92% at a mean followup of 42 months; buccal mucosal graft (BMG) urethroplasty (133 cases) was 89% at a mean follow-up of 19 months; vaginal graft augmentation (44 cases) was 87% at a mean follow-up of 15 months; and labial graft reconstruction (19 cases) was 89% at a mean follow-up of 18.4 months. The dorsal approach of graft augmentation met with 88% (95% confidence interval [CI] 0.79-0.95) success compared with 95% (95% CI 0.86-1) for the ventral approach. Conclusion: FUS is a rare condition requiring a meticulous diagnostic workup using multiple tests. All urethroplasties have shown better pooled success rates (86%-93%) compared with dilatation (49%). BMG is equally effective as vaginal graft urethroplasty.

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Section: Resultsmentioning

confidence: 99%

Deciphering the enigma of female urethral strictures: A systematic review and meta‐analysis of management modalities

Sarin

Narain

Panwar

et al. 2020

Neurourology and Urodynamics

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“…No case series are available on ventral inlay (where graft is placed through the urethra and no dissection is done between the urethral and the vaginal plane), and there is only a case report of the ventral-inlay technique. [17] Several review articles[11819] are available in the literature on ventral-onlay technique, but none describes the ventral-inlay technique including the recent studies[102021222324] available in the literature. We report our experience of ventral-inlay buccal mucosal graft urethroplasty (VI-BMGU) in patients with female urethral stricture disease (USD).…”

Section: Introductionmentioning

confidence: 99%

Ventral-inlay buccal mucosal graft urethroplasty for female urethral stricture

2019

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Introduction:The aim of the study is to present our initial experience with ventral-inlay buccal mucosal graft urethroplasty (VI-BMGU) in female urethral stricture disease (USD).Methods:Between May 2016 and June 2018, 12 women with USD underwent VI-BMGU. All women were evaluated preoperatively with the American Urological Association (AUA) symptom score, uroflowmetry, calibration with a 12 Fr catheter, and ultrasonography with postvoid residual (PVR) urine measurement. Intraoperative confirmation of stricture was done with a 6 Fr cystoscope. Postoperatively, the women were followed at 3, 6, and 12 months after surgery with AUA symptom score, uroflowmetry, and PVR estimation. Increase in AUA symptom score, maximum flow rate (Qmax) <12 ml/s, and failure to calibrate with 18 Fr catheters were considered as indicative of recurrence of the disease.Results:The mean age of the patients was 41 years. The mean follow-up period was 18 months. All women voided successfully after catheter removal. There was an improvement in AUA symptom score and Qmax and a reduction in PVR at 3, 6, and 12 months. One woman had recurrence of stricture at 6 months and was treated by urethral dilatation followed by the institution of a self-dilatation regimen. The success rate was 92% in our case series.Conclusions:VI-BMGU is a simple and safe method of urethroplasty in women. Studies with a larger sample size and a longer follow-up are required to document the long-term success of this procedure.

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“…It is widely accepted that outcomes from urethral dilatation are often only good in the short term and that, for long‐term benefits, ISC is required. There is increasing evidence to suggest that urethroplasty may be the ‘gold standard’ for achieving long‐term stricture‐free and ISC‐free life . Over the years a number of urethroplasty techniques have been described: flap (vaginal , vestibular or pedicled labia minora ); graft (vaginal , labia minora , lingual or BMG ); ventral and dorsal approaches ; and inlay and onlay placements.…”

Section: Discussionmentioning

confidence: 99%

“…Limitations of the study include the relatively low overall numbers (although they are large for a female urethroplasty series), the medium‐term nature of the follow‐up and the lack of validated patient‐reported outcomes. There are currently no validated outcome measures for women with urethral stricture, the majority of whom have a combination of urethral pain, irritative and obstructive symptoms ; however, early‐ to medium‐term experience suggests that ventral onlay BMG substitution urethroplasty is a highly efficacious, reproducible urethroplasty technique in the treatment of refractory recurrent urethral stricture in women, with low complication rates.…”

Section: Discussionmentioning

confidence: 99%

“…Female urethral stricture (FUS), although uncommon, has a large impact on quality of life, with urethral pain and recurrent infections causing much misery. BOO in women may be more common than previously believed, occurring in [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22].4% of women presenting with LUTS [1,2], with FUS causing BOO and LUTS in 0.32-4.9% of cases [3][4][5]. Traditionally FUS has been managed using endoscopic techniques with or without intermittent self-catheterization (ISC).…”

Section: Introductionmentioning

confidence: 99%

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Ventral‐onlay buccal mucosa graft substitution urethroplasty for urethral stricture in women

et al. 2017

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Female urethral stricture: a contemporary series

Abstract: Urethroplasty in its various forms has demonstrated in the present series the highest cure rate for the treatment of recurrent urethral stricture.

Cited by 43 publications

References 15 publications

Deciphering the enigma of female urethral strictures: A systematic review and meta‐analysis of management modalities

Deciphering the enigma of female urethral strictures: A systematic review and meta‐analysis of management modalities

Ventral-inlay buccal mucosal graft urethroplasty for female urethral stricture

Ventral‐onlay buccal mucosa graft substitution urethroplasty for urethral stricture in women

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