Female urethral stricture: A multi‐centre experience and lessons learnt

Abstract

Abstract Objectives To review demographics, surgical techniques and outcomes of female patients undergoing buccal mucosal graft substitution urethroplasty. Materials and methods An international multi‐institutional study was performed through a retrospective review of a prospectively managed database of female urethroplasty outcomes at two sites from December 2016 to June 2023. Institutions included a high‐volume tertiary referral centre performing 500 urethroplasties annually, and a regional centre with a fellowship‐trained urethroplasty surgeon performing ~50 urethroplasties annually. Female urethroplasty accounted for 2% of urethroplasties performed, utilising dorsal onlay, ventral inlay and double‐face techniques. Results Forty‐two patients underwent female urethroplasty between 2016 and 2023; 20 dorsal onlay grafts, 14 ventral inlay grafts and 8 double‐face urethroplasty. The mean age was 45 years (SD 12.07) and mean follow‐up 27 months (SD 17.22). The most common aetiology was idiopathic in 59%. The most common presenting symptom was obstructive lower urinary tract symptoms in 86%. Urethral dilatations were the most common treatment before urethroplasty, with a mean of 9 (SD 1.2) dilations pre‐urethroplasty. Stricture locations seen were; proximal 7%, proximal to mid‐14%, mid‐31%, mid to distal 10% and distal 38%. A total of 88% were successful overall; dorsal onlay was 100%, ventral inlay urethroplasties 71% and double‐face 88%. Mean Qmax improvement was 291% at 6 months. In those who required dilatations or further surgery postoperatively (n = 5); four were ventral inlay (one mid‐distal, three distal), and one double‐face distal stricture. All patients including those requiring secondary treatments were continent and did not require intermittent self‐catheterisation or suprapubic catheter insertion. Conclusion Urethroplasty is an effective long‐term therapeutic option for managing female urethral strictures. Dorsal onlay urethroplasty demonstrated the highest success rate, and stands out as a versatile technique, addressing distal to proximal urethral strictures. However, the chosen urethroplasty technique should be tailored to the characteristics of the stricture, patient and surgeons experience.

Keywords

• buccal mucosa
• female urethroplasty
• graft
• reconstructive urology
• urethra
• urethral stricture