Urethral strictures in women are rare, and they account for only about 15% of women with BOO. Urethral obstruction in women is functional or anatomical.
When the obstruction is anatomical, it can be secondary to compression or scar. Compressive obstruction can result from prolapse, urethral diverticulum or tumor. Strictures may be iatrogenic, idiopathic or traumatic, or as a result of deterioration.
Because urethral strictures are so uncommon and high quality studies are few and far between, the management of urethral strictures in women is largely experimental. Treatment options typically include urethral dilation, self-catheterization, urethrotomy and urethroplasty.
Although data is limited, it appears that urethral dilation is of benefit only in the short term, which is measured in months, not years. In our study, only 1 of 17 patients had a continual response to urethral dilation alone. This suggests that definitive surgical treatment should be considered when conservative measures fail or when stricture is associated with partial or complete loss of the urethral wall.
Urethral Strictures in Women: Techniques
A variety of surgical techniques have been described for urethral strictures in women, including VFU, dorsal urethroplasty with labia minora, lingual graft, skin graft or pedicle flap, vestibular flap urethroplasty and buccal mucosal graft urethroplasty. Each procedure utilizes a variation on two basic urethroplasty approaches – the vaginal flap and vaginal wall grafts.
Vaginal flap neourethral restoration for urethrovaginal fistula was first described in 1935. After urethral catheterization has been completed, a U-shaped flap is created on the anterior vaginal wall. The stricture is incised and the flap is advanced, which avoids grafting or tunneling the tissue and has few problems.
Buccal mucosal graft urethroplasty has been successfully applied to both male and female urethral stricture disease. Advantages include hairless tissue that is accustomed to a damp environment and has elasticity. It is an option when there is inadequate vaginal tissue for grafting.
What is Urocenter of New York’s Experience Treating Urethral Strictures in Women?
For treatments of urethral strictures at URO Center of New York, the urethra is incised dorsally until healthy proximal urethra is identified. We use the resistance experienced during the withdrawal to assess the residual stricture. Subsequently, the graft is sutured into the urethra and covered with periurethral tissue.
Bottom Line: Urethral stricture is uncommon in women and literature on the topic is sparse. In our experience with 17 consecutive women with urethral stricture seen in a 12-year period, urethral dilation was rarely effective.
Urethroplasty had a 100% success rate at 1 year in 9 women but strictures recurred at 6 years in 2 who underwent ventral vaginal flap urethroplasty, requiring repeat urethroplasty with a buccal mucosal graft. Women with urethral strictures should be monitored for a longer term due to the small risk of recurrence.
Dr. Jerry Blaivas is the World Leading Expert on Complicated Urological Problems
Uro Center of New York
Jerry G. Blaivas, MD, FACS
445 East 77th Street
New York, NY 10075