Lateral-based Anterior Vaginal Wall Flap in the Treatment of Female Urethral Stricture: Efficacy and Safety

Abstract

Background: Female urethral stricture is a rare condition. Different types of urethroplasty have been described. However, high quality studies are sparse. The most common technique used-the Blandy's technique-has resulted in our cases in a retrusive meatus and an inward urinary stream. Objective: To show the efficacy and safety of an alternative vaginal wall flap urethroplasty.Design, setting, and participants: A cross-sectional observational study was undertaken in a single University Hospital. Nine female patients previously diagnosed with urethral stricture at our institution underwent open surgery from 1993 to 2015. They were contacted and agreed to undergo a medical examination.Surgical procedure: A ventral lateral-based anterior vaginal wall flap urethroplasty inspired by the Orandi technique for male urethroplasty was performed.Measurements: A chart review was performed. Results and limitations: The mean age was 56 yr (41-78 yr). The mean follow-up was 80.7 mo (12-198). All patients had relief of symptoms. The meatus of all patients stayed in an orthotopic position without any impact on the direction of the urinary stream. The average caliber of the urethra increased from 10.8 Fr (6-18 Fr) to ≥20 Fr. Peak flow improved from a mean of 6.8ml/s (3-11ml/s) to 21ml/s (14-35ml/s). No patient developed stricture recurrence or de novo stress urinary incontinence. There were no other immediate or delayed complications. All patients achieved a better score on the Patient Global Impression of Improvement questionnaire.Conclusions: Our study, with the same limitations that the few studies published in this field had, that is the few patients included, demonstrates that lateral anterior vaginal wall flap urethroplasty is an effective technique, offering durable results without apparent complications.Patient summary: We studied an alternative surgical technique for the treatment of female urethral stricture. We conclude that it is safe and effective with no apparent complications and good long-term results.