Reconstruction of the urethra with an anterior vaginal mucosal flap in female urethral stricture.

Abstract

We present our single institution experience with urethral reconstruction by using anterior U-shaped vaginal flap in female patients with urethral stricture. Retrospective analysis was performed from March 2014 to April 2018. Fourteen patients with retention or severe voiding dysfunction and failed conservative management were enrolled. The demographic characteristics, vaginal examination, urodynamic parameters, and post-void residual urine (PVR) were reviewed. Patient Global Impression of Improvement (PGI-I) and American Urological Association (AUA) symptom index were completed pre- and post-operatively. In the dorsal lithotomy position, the Foley catheter was inserted and two parallel anterior vaginal walls incised around the urethral meatus. After dissection and the vaginal flaps were flipped up, the dorsal part of the urethra was incised vertically to pass the stricture and the distal end of the vaginal flap sutured to the proximal end of the urethra and inner part of the flap was tabularized over the larger size of Foley's catheter. The second layer of the folded vaginal flap was sutured to native vagina. In all the patients, voiding LUTS improved or was cured. Average postoperative maximum urinary flow rate (Qmax) was 15.82 ± 3.27ml/s and PVR was 27.35 ± 18.76ml. During the follow-up, new onset of urgency and worsening urge incontinence were reported. Two patients suffered from stress urinary incontinence (SUI) after surgery, but in 1 patient it improved after 6 months and in the other due to the persistent SUI, trans-obturator tape (TOT) was applied after 12months. Most patients had a high level of satisfaction and improvement of lower urinary tract symptoms (LUTS). Hence, anterior vaginal flap urethroplasty is a safe and effective technique and may be utilized in the management of the initial phases of female urethral stricture after a multicenter prospective trial.