Abstract
Female urethral stricture (FUS) is a rare condition. It was not studied robustly for many years, but interest has grown recently in the reconstructive urology community, leading to an increase in publications. In this review, we gather the latest data regarding FUS and its different therapeutic options. Studies are summarized, split by technique. We also review the recently published European Guidelines. In addition, we share our preferred surgical technique and our views on future options. Diagnosing FUS can often be challenging and requires a high index of clinical suspicion. Its vague clinical symptoms and empiric initial treatments combine to make FUS an underdiagnosed condition. The lack of consensus on how to define FUS also compounds the problem. Appropriate diagnosis requires thorough investigation, and ancillary studies such as video urodynamics, cystoscopy, and voiding cystourethrogram may be useful. Treatment options range from conservative management to definitive procedures, although studies have shown that conservative measures such as urethral dilation have a low success rate overall. Within definitive management, augmented urethroplasty - using either flaps or grafts, has proven to be the gold standard. Both have shown excellent results over time; however, there is insufficient data available to recommend one over the other. Contemporary data has an overall poor level of evidence. Although challenging due to the rarity of the problem, a proper randomized controlled clinical trial comparing the principal surgical options and their outcomes would be beneficial and would allow for more informed decision making when considering options for women with urethral stricture.
Highlights
Bladder outlet obstruction (BOO) in women remains a challenging scenario
The decision to place a ventral graft relies on the presumption that it is an easier dissection and that it would preserve sexual function, there is one study that showed that sexual function is not affected with dorsal approach and, even more, it documented an improvement in sexual function scores[38]
Lane et al.[25] reported that 14% of patients undergoing augment urethroplasty required a suprapubic tube placement preoperatively, and 14% of patients intraoperatively
Summary
Bladder outlet obstruction (BOO) in women remains a challenging scenario. Care needs to be taken not to confuse functional entities with anatomic to offer appropriate care to the patient. Female urethral stricture (FUS) disease accounts for a considerable proportion ranging from 4% to 18% of women with BOO[1]. Serial urethral dilation is an acceptable option for managing symptoms, but its high failure rate makes it a substandard choice when considering definitive treatment. The goals for female urethral reconstruction are to restore function, urinate without obstruction, maintain continence, prevent vaginal voiding, and maintain sexual function These goals are considered an ideal scenario, there is a dearth of literature considering all five variables when analyzing outcomes. In cases where there is an isolated distal urethral stricture, meatoplasty should be considered This usually occurs after traumatic instrumentation, radiation therapy to the pelvis, and more commonly in postmenopausal patients with vulvar and vaginal atrophy. The anterior vaginal wall flap and lateral vaginal wall flap techniques have proven safety and efficacy,
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