Female Urethral Stricture Management: The Initial Experience of an Female Pelvic Medicine and Reconstructive Surgery-Trained Urologist.

OBJECTIVE

Given the rarity of female urethral strictures (the cause of <1% of female lower urinary tract symptoms), most trainees have little experience diagnosing and managing the problem as they begin practice. Presented are the female urethral stricture outcomes of an attending surgeon after the completion of a female pelvic medicine and reconstructive surgery fellowship.

METHODS

With institutional review board approval, a retrospective review of all cases of suspected female urethral stricture through the first 7 years of practice was completed.

RESULTS

Over the study period, 13 women were treated for urethral stricture. One underwent simple meatotomy, 9 underwent vaginal wall flap (Blandy) urethroplasty, and 3 underwent urethral dilation only because they were not reconstructive candidates (1 due to severe radiation damage and 2 with panurethral strictures that included the bladder neck). Women undergoing urethral dilations (n = 3) have all required subsequent dilations, whereas those undergoing reconstructive procedures have not required further intervention (all with max flow rates greater than 17 mL/s at last follow-up [median = 35 months, range = 10-70]).

CONCLUSION

Over the course of 7 years, our limited experience suggests that (a) urethral dilation is not usually successful but surgical reconstruction is, (b) preoperative urethral rest before reconstruction may reduce failure rates, (c) staging a stricture in the operating room is the best route to confirm the diagnosis, (d) de novo stress urinary incontinence seems to rarely if ever occur after female urethroplasty, and (e) postoperative follow-up with simple uroflow and postvoid residual testing suffices.