Female urethral stricture

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ObjectiveThe aim of the present report was to provide an up-to-date overview of the existing literature on female urethral stricture (FUS) including its definition, epidemiology, risk factors, diagnostic and therapeutic approaches. MethodsA literature search was conducted in January 2024 using the MedLine and Embase databases, screening for randomized controlled trials (RCTs), prospective and retrospective series and reviews on female urethral stricture. ResultsUrethral stricture is a rare occurrence in female patients. However, as it can be responsible of any LUTS, a high level of suspicion is needed to avoid underdiagnosis which results in burdensome persisting LUTS in these patients, severely affecting their quality of life. PVR and uroflowmetry are the cornerstones of the screening process that should be used in every female patient with LUTS. Conversely, overdiagnosis and overuse of “random” urethral dilation could be equally harmful by generating FUS and a stringent and rigorous diagnostic process including urethrocystoscopy, urodynamics and fluoroscopy is needed to make the proper diagnosis. When FUS has been formally diagnosed, a single session of endoscopic treatment, ideally urethral dilation can be attempted. As in male patients, urethroplasty is the next step for any recurrence with various techniques being available (buccal mucosa vs vaginal flap; dorsal vs ventral onlay) with no robust evidence to support one over the other but which all yield satisfoactory outcomes with>85% of success. ConclusionFUS is a rare occurrence but should be ruled out in every female LUTS. While endoscopic treatment is the first line management, several successful female urethroplasty techniques can be used to treat patients with recurrent FUS. The level of evidence on the diagnosis and treatment of FUS is overall very low.