Intermediate Outcomes After Female Urethral Reconstruction: Graft vs Flap

Abstract

To evaluate the outcomes of women after urethral reconstruction with a vaginal flap urethroplasty (VFU) or dorsal buccal mucosal graft (BMG). We retrospectively identified 10 women undergoing urethral reconstruction between February 2007 and October 2012. All patients had evidence of urethral stricture on cystoscopy and/or urodynamic study indicating bladder outlet obstruction. Recurrent stricture was defined using the same criteria. Follow-up included urethral calibration (>16F), symptom assessment, voiding cystourethrogram, and cystoscopy when there was difficulty voiding or symptoms recurred. Mean age was 49 years (range, 32-74). The indication for urethral reconstruction was urethral stricture in 9 patients. One woman had a traumatic 2-cm ventral urethral laceration associated with a pelvic fracture. Location was mid in 6 and distal in 4 women. Average stricture length was 1.25 cm (range, 0.2-2). All patients with urethral stricture had previously undergone multiple urethral dilations. There were no major postoperative complications. Two patients undergoing VFU had a recurrent stricture requiring dilation. No patients undergoing dorsal BMG had a recurrent stricture. Female urethral reconstruction, either VFU or dorsal BMG, is a safe and successful procedure that should be offered to women with urethral strictures. The dorsal BMG approach is well tolerated and results are promising, but longer-term follow-up is needed. Women should be offered urethral reconstruction as a definitive management option rather than repeated urethral dilations.