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Atik YT, Uysal B, Gul D, Cimen HI, Aydemir H, Bostanci MS, Kose O. Female ventral-onlay buccal mucosal graft urethroplasty supported with martius labial fat pad flap: early results. Int Urol Nephrol 2024; 56:1927-1933. [PMID: 38240930 DOI: 10.1007/s11255-023-03909-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/04/2023] [Indexed: 05/14/2024]
Abstract
PURPOSE There is a growing interest in reconstructive urology and female urethroplasty. We aimed to report our experience in ventral-onlay buccal mucosa graft (BMG) urethroplasty supported with Martius flap (MF) in treating female urethral stricture disease. METHODS We retrospectively evaluated data of 18 female patients (ages 35-78) who were diagnosed with urethral stricture disease and underwent ventral-onlay BMG urethroplasty supported with MF by single surgeon in a tertiary referral centre between February 2019 and October 2022. Detailed history, international prostate symptom score (IPSS), pelvic examination, urine flow rate (rate and pattern), post void residual (PVR), storage and voiding phase urodynamic study, and voiding cystourethrography were recorded. At the last visit; the number of urethral dilatations before urethroplasty, time from urethral dilation to urethroplasty, hospital stay, urethral catheterization time, postoperative IPSS, PVR and uroflowmetry values were recorded. RESULTS The presenting symptoms were obstructive voiding symptoms in 16 patients. While the mean number of urethral dilatation was 2.11 ± 1.93 (1-7), the mean time from dilatation to urethroplasty was 5.83 ± 5.00 (1-19 months) months. Maximum flow rate increased from 8.36 ± 3.26 ml/sec in preoperative uroflowmetry to 21.45 ± 5.27 ml/sec at the last follow-up (p < 0.001). Post-void residual urine (PVR) decreased from preoperative mean 116.66 ± 105.88 cc to 26.94 ± 22.69 cc postoperatively (p < 0.004). None of the patients developed stricture recurrence, incontinence or vaginal fistula until the last follow-up. The mean follow-up period was 17.28 ± 11.65 (1-35) months. CONCLUSIONS A ventral-onlay BMG urethroplasty supported with MF represents an effective and reproducible treatment option for FUS in the present study.
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Affiliation(s)
- Yavuz Tarik Atik
- Department of Urology, Sakarya University, Training and Research Hospital, Sakarya, Turkey.
| | - Burak Uysal
- Faculty of Medicine, Department of Urology, Sakarya University, Sakarya, Turkey
| | - Deniz Gul
- Department of Urology, Sakarya University, Training and Research Hospital, Sakarya, Turkey
| | - Haci Ibrahim Cimen
- Faculty of Medicine, Department of Urology, Sakarya University, Sakarya, Turkey
| | - Huseyin Aydemir
- Department of Urology, Sakarya University, Training and Research Hospital, Sakarya, Turkey
| | - Mehmet Suhha Bostanci
- Faculty of Medicine, Department of Gynecology and Obstetrics, Sakarya University, Sakarya, Turkey
| | - Osman Kose
- Faculty of Medicine, Department of Urology, Sakarya University, Sakarya, Turkey
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Bouchard B, Campeau L. Surgery for female urethral stricture. Neurourol Urodyn 2024. [PMID: 38197721 DOI: 10.1002/nau.25358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/26/2023] [Accepted: 11/29/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Female urethral stricture (FUS) is a rare entity that causes great morbidity and suffering in those affected. As the available scientific data is sparce, there are no formal guidelines or standard of care for this disease. METHODS This is a narrative review of the surgical management for female urethral stricture. The literature review was performed on PubMed. Articles were limited to English, but there was no limitation in terms of date. RESULTS Management of FUS is divided between endoscopic and open surgical repair. Urethral dilation with or without urethrectomy can be offered as a first-line treatment. However, the rate of success of this procedure remains inferior to open surgical repair, and its efficacy decreases with the number of previous dilations. For distal urethral strictures, distal urethrectomy and advancement meatoplasty may be considered. Vaginal flaps are readily available, easy to harvest, well-vascularized, and allow for a dorsal or ventral orientation urethroplasty. The results of this procedure are promising, but most studies are small and retrospective. Labia flaps are easily accessible, wet, hairless, and elastic. The main limitations with the use of vaginal or labial tissues are co-existing conditions such as lichen sclerosis or vaginal atrophy, which may affect future results. Vaginal and labial graft urethroplasty can be used when it is not possible to mobilize an adequate flap. Stricture-free rates of this technique are variable. In cases of more severe stricture, an augmentation urethroplasty using buccal mucosa graft may be necessary. The techniques used in FUS replicate those for male urethral strictures, where both ventral and dorsal approaches can be utilized. CONCLUSIONS Although there is growing interest in the field, the optimal management of FUS remains to be determined.
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Affiliation(s)
- Béatrice Bouchard
- Division of Urology, Université de Montréal, Montréal, Quebec, Canada
| | - Lysanne Campeau
- Division of Urology, Department of Surgery, Montreal Jewish General Hospital, McGill University, Montreal, Canada
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Higgins MM, Wengryn D, Koslov D, Oliver J, Flynn BJ. Female urethroplasty with dorsal onlay buccal mucosal graft: a single institution experience. Int Urol Nephrol 2023. [PMID: 36859624 DOI: 10.1007/s11255-023-03520-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/13/2023] [Indexed: 03/03/2023]
Abstract
PURPOSE Female urethral stricture disease is frequently unrecognized or misdiagnosed, with controversy in the literature regarding the definition of strictures and approach to management. The purpose of this study is to report our institutional experience with female urethroplasty and add our experience to the growing body of research. METHODS We performed a retrospective review of patients undergoing female urethroplasty with dorsal onlay BMG at the University of Colorado between March 2015 and December 2021 performed by two surgeons (BF and JO). The primary outcome measure was surgical success, defined as no stricture recurrence. The secondary outcome measure was the incidence of de novo urinary incontinence. RESULTS 23 patients were included in our data analysis. The median duration of lower urinary tract symptoms prior to urethroplasty was 16 years. 87% had undergone previous dilations. At a median follow-up of 12.2 months (range 1-81 months), four patients required a secondary procedure for obstruction with an overall success rate of 83%. One patient developed de novo stress urinary incontinence and one patient developed urge urinary incontinence. Subgroup analysis was performed comparing the patients that developed stricture recurrence (N = 4) to those that did not (N = 19). Those with stricture recurrence had a longer duration of symptoms and more dilations prior to urethroplasty. CONCLUSION Female urethroplasty with BMG is effective at treating female urethral stricture disease, with excellent outcomes at over a year of follow-up and minimal risk of stress incontinence postoperatively.
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Blair Y. How Do We Assess Success After Surgical Management of Urethral Stricture Disease? Curr Bladder Dysfunct Rep 2023. [DOI: 10.1007/s11884-023-00686-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Abstract
PURPOSE OF REVIEW To provide an overview of female urethral stricture disease and updates on surgical outcomes. RECENT FINDINGS In a large retrospective case series, women reported significant improvements in urinary symptoms and quality of life following treatment of their urethral stricture. Both vaginal flap and buccal mucosal graft urethroplasty have higher short- and long-term success rates than urethral dilation. Female urethral stricture disease is rare and surgical reconstruction has the highest likelihood of long-term success. Due to the complexity of reconstruction, referral to a reconstructive trained urologist should be considered.
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Affiliation(s)
- Jack Campbell
- Urology Institute, Lahey Hospital & Medical Center, Burlington, MA, USA.,Department of Urology, Medical Center, University of Kansas, Kansas City, KS, USA
| | - Alex J Vanni
- Urology Institute, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Casey G Kowalik
- Department of Urology, Medical Center, University of Kansas, Kansas City, KS, USA. .,Department of Urology, University of Kansas Health System, 3901 Rainbow Blvd, Kansas City, KS, 66201, USA.
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Peyronnet B, Lapitan MC, Tzelves L, O'Connor E, Nic An Riogh A, Manso M, Yuhong Yuan C, Arlandis S, Bo K, Costantini E, Farag F, Groen J, Nambiar A, Phé V, van der Vaart H, Imran Omar M, Harding C. Benefits and Harms of Conservative, Pharmacological, and Surgical Management Options for Women with Bladder Outlet Obstruction: A Systematic Review from the European Association of Urology Non-neurogenic Female LUTS Guidelines Panel. Eur Urol Focus 2022; 8:1340-1361. [PMID: 34702649 DOI: 10.1016/j.euf.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/11/2021] [Accepted: 10/05/2021] [Indexed: 12/16/2022]
Abstract
CONTEXT While the management of bladder outlet obstruction (BOO) in men has been a topic of several systematic reviews and meta-analyses, no such evidence base exists for female BOO. OBJECTIVE The aim of this systematic review was to evaluate the benefits and harms of therapeutic interventions for the management of BOO in women. EVIDENCE ACQUISITION This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The study protocol was registered with PROSPERO (CRD42020183839). A systematic literature search was performed and updated by a research librarian in May 2021. The study population consisted of adult female patients diagnosed with BOO, who underwent treatment. EVIDENCE SYNTHESIS Out of 6344 records, we identified 33 studies enrolling 1222 participants, of which only six randomized controlled trials (RCTs) were found. One placebo-controlled crossover randomized trial assessed the role of baclofen in 60 female patients with dysfunctional voiding. The trial met its primary endpoint with a significantly greater decrease in the number of voids per day in the baclofen group (-5.53 vs -2.70; p = 0.001). The adverse events were mild and comparable in both groups (25% vs 20%). One placebo-controlled crossover randomized trial assessed the role of sildenafil in 20 women with Fowler's syndrome. There were significant improvements from baseline in maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and postvoid residual (PVR), but with no statistically significant difference when compared with placebo. In a large RCT including 197 female patients with functional BOO, the alpha-blocker alfuzosin significantly improved IPSS, Qmax, and PVR compared with baseline, but the differences were not statistically significant compared with the placebo group. Several small single-arm prospective series reported improvement of BOO-related symptoms and voiding parameters with urethroplasty, sling revision, urethral dilation, vaginal pessary, and pelvic organ prolapse repair. CONCLUSIONS Evidence to support the use of conservative, pharmacological, and surgical treatments for BOO is scarce. PATIENT SUMMARY According to the present systematic review of the literature, evidence to support the use of conservative, pharmacological, and surgical treatments for either anatomical or functional bladder outlet obstruction is scarce.
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Affiliation(s)
| | | | - Lazaros Tzelves
- Sismanoglio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | - Cathy Yuhong Yuan
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Kari Bo
- Norwegian School of Sport Sciences, Department of Sports Medicine, Oslo and Akershus University Hospital, Lørenskog, Norway
| | | | | | - Jan Groen
- Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Véronique Phé
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpetrière Academic Hospital, Sorbonne University, Paris, France
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Alvarez de Toledo I, DeLong J. Female Urethral Reconstruction. Urol Clin North Am 2022; 49:393-402. [DOI: 10.1016/j.ucl.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Pathak RA, Geiger X, Ericson C, Wilson RRA, Petrou SP. Histologic Analysis of Urethral Stricture in 9 Patients Following Dorsal Vaginal Graft Urethroplasty. Am J Clin Pathol 2022; 157:742-747. [PMID: 34724532 DOI: 10.1093/ajcp/aqab183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/19/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To present the pathologic analysis of female urethral strictures obtained during reconstructive urethroplasty. METHODS Nine separate female urethral tissue specimens were obtained during dorsal vaginal graft urethroplasty by a single surgeon (S.P.P.). Samples were serially sectioned and fixed in 10% formalin 6 to 12 hours before routine processing in paraffin blocks. Serial 5-µm sections were subjected to H&E, Masson trichrome, and elastin staining. End point analysis included evaluation for epithelial hyperplasia and cell type, mucosal edema, degree of fibroblast/inflammatory cell infiltrate, and elastin fiber density and distribution. RESULTS Nine specimens were examined. Six specimens had epithelial linings of stratified squamous epithelium overlying fibrosis (67%), 1 had mixed squamous and urothelial epithelium, and 2 had only urothelial epithelium. Two specimens (29%) showed acute injury with prominent squamous papillary hyperplasia, focal erosion, and patchy mucosal hemorrhage. Areas of urethral stricture were variably thickened, with increased, densely packed collagen fibers and associated mucosal lymphocytic inflammation ranging from mild and patchy to focally dense with lymphoid aggregates. The highest elastin fiber density appeared to be associated with vessels and overlying muscle bundles in the submucosa. CONCLUSIONS Further elucidation of histopathologic characteristics may illuminate more appropriate therapeutic pathways for female urethral stricture disease management.
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Affiliation(s)
- Ram A Pathak
- Department of Urology, Wake Forest University, Winston-Salem, NC, USA
| | | | | | | | - Steven P Petrou
- Department of Urology, Wake Forest University, Winston-Salem, NC, USA
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Marantidis J, Sussman RD. Etiology and Evaluation of Female Urethral Strictures. Curr Bladder Dysfunct Rep 2022. [DOI: 10.1007/s11884-021-00637-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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10
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Tahra A, Sobay R, Küçük EV. Quality of life is improved after urethroplasty in women with urethral stricture. Int Urogynecol J 2022; 33:597-603. [PMID: 34999913 DOI: 10.1007/s00192-021-05026-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/04/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To evaluate the quality of life (QoL) in women who underwent urethroplasty for urethral stricture. METHODS Twenty-two women who underwent ventral labium minus graft urethroplasty were included. Patients were assessed with uroflowmetry, urethral caliber and post-voiding residual urine (PVR). American Urological Association (AUA) symptom score, Urogenital Distress Inventory (UDI)-6 and Short Form-36 (SF-36) were used to evaluate QoL. Preoperative values were compared with patients' last visit data. The cure of the surgery was defined as a maximum flow rate > 15 ml/s in uroflowmetry and no need for any further intervention. RESULTS Median age was 55 (40-66) years. Cure was achieved in 20 (90.3%) patients with median 37 (13-52) months follow-up duration. The median Qmax increased from 4 (0-5) ml/s to 27.5 (8-55) ml/s (p < 0.001). Median post-void residual volume (PVR) decreased from 52.5 (0-120) ml to 20(0-60) ml (p = 0.011). Both AUA symptom score [from median 30 (24-35) to 4.5 (0-20), p < 0.001] and AUA-QoL score [from median 5 (4-6) to 0(0-3), p < 0.001] decreased after surgery. Median UDI summary score at the last follow-up was 0 (0-44.4), which was 33.3 (22.2-61.05) at baseline visit. Improvement was observed in all domains except the 'Energy/Fatigue' domain of the SF-36. CONCLUSIONS Urethroplasty is an effective surgical method to improve patients' QoL which is impaired because of female urethral stricture.
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Affiliation(s)
- Ahmet Tahra
- Department of Urology, Health Sciences University, Umraniye Training & Research Hospital, Istanbul, Turkey. .,Department of Urology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey.
| | - Resul Sobay
- Department of Urology, Health Sciences University, Umraniye Training & Research Hospital, Istanbul, Turkey
| | - Eyüp Veli Küçük
- Department of Urology, Health Sciences University, Umraniye Training & Research Hospital, Istanbul, Turkey
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Richard C, Peyronnet B, Drain A, Rosenblum N, Hascoet J, Sussman RD, Freton L, Zhao LC, Nitti VW, Brucker BM. Dorsal Onlay Oral Mucosa Graft Urethroplasty for Female Urethral Stricture. Urology 2021; 158:215-221. [PMID: 34537197 DOI: 10.1016/j.urology.2021.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To describe and assess the outcomes of dorsal onlay oral mucosa graft urethroplasty for female urethral stricture. METHODS We retrospectively reviewed the charts of all female patients who underwent dorsal onlay oral (buccal or lingual) mucosa urethroplasty for urethral stricture between 2011 and 2020 at two academic institutions. The primary endpoint was clinical success defined as any subjective improvement in LUTS self-assessed by the patients 1-3 months after catheter removal. Four surgeons performed the urethroplasties using a standardized technique: suprameatal incision, dissection and longitudinal opening of the dorsal aspect of the urethra, harvest of the oral mucosa graft, graft onlay sutured into the urethral opening. RESULTS Nineteen patients were included. The clinical success rate was 94.7% at 1-3 months and 90.9% at 1 year. After a median follow-up of 12 months (range 1-49) there was one recurrence (5.3%), clinical success was achieved in 17 patients (89.5%) and both the maximum urinary flow rate and post void residual were significantly improved (15.2 vs 7.4 ml/s preoperatively; P = .008 and 71.5 vs 161.1 ml preoperatively; P = .001 respectively). The de novo stress urinary incontinence rate was 15.7% at 1-3 months and 9.1% at 1 year. CONCLUSION Dorsal onlay oral mucosa graft urethroplasty for female urethral stricture appears feasible across multiple surgeons and is associated with a low perioperative morbidity, satisfactory functional outcomes and a low recurrence rate. Other series with larger sample size and longer follow-up are needed to confirm these findings.
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Affiliation(s)
- Claire Richard
- Department of Urology, University of Rennes, Rennes, France
| | | | - Alice Drain
- Department of Urology, New York University Langone Health, New York, NY
| | - Nirit Rosenblum
- Department of Urology, New York University Langone Health, New York, NY
| | | | - Rachael D Sussman
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC
| | - Lucas Freton
- Department of Urology, University of Rennes, Rennes, France
| | - Lee C Zhao
- Department of Urology, New York University Langone Health, New York, NY
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Richard C, Hascoet J, Haudebert C, Rigole H, Freton L, Samson E, Voiry C, Peyronnet B. [Female voiding dysfunction: Clean intermittent catheterization is not the only option]. Prog Urol 2021; 31:924-930. [PMID: 34456140 DOI: 10.1016/j.purol.2021.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
Female voiding dysfunction exists but are largely underdiagnosed, especially in France. They can result from two different mechanisms: detrusor underactivity or bladder outlet obstruction, with very different pathophysiology and therapeutic management. There are many different therapeutic options, including surgical treatments, to offer as alternative to clean intermittent catheterization which are often burdensome for patients. Seeking voiding dysfunction in female patients with lower urinary tract symptoms and searching for their etiology to tackle it could lead to a paradigm change in these women: from standardized treatment to individualized treatment. In their practice, nurses can detect warning symptoms suspect of voiding dysfunction, and have thus a role to play in the improvement of patients' screening, education other healthcare providers, and management of female voiding dysfunction.
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Affiliation(s)
- C Richard
- Service d'urologie, CHU de Rennes, 2, rue Henri Le Guilloux, 35000 Rennes, France.
| | - J Hascoet
- Service d'urologie, CHU de Rennes, 2, rue Henri Le Guilloux, 35000 Rennes, France
| | - C Haudebert
- Service d'urologie, CHU de Rennes, 2, rue Henri Le Guilloux, 35000 Rennes, France
| | - H Rigole
- Service de médecine physique et réadaptation, CHU de Rennes, Rennes, France
| | - L Freton
- Service d'urologie, CHU de Rennes, 2, rue Henri Le Guilloux, 35000 Rennes, France
| | - E Samson
- Service de médecine physique et réadaptation, CHU de Rennes, Rennes, France
| | - C Voiry
- Service de médecine physique et réadaptation, CHU de Rennes, Rennes, France
| | - B Peyronnet
- Service d'urologie, CHU de Rennes, 2, rue Henri Le Guilloux, 35000 Rennes, France
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Gülpınar Ö, Zumrutbas AE, Sancı A, Bütün S, Gokce Mİ, Aybek Z. The outcomes of three buccal mucosal graft urethroplasty techniques in women with urethral stricture disease. Neurourol Urodyn 2021; 40:1921-1928. [PMID: 34368998 DOI: 10.1002/nau.24764] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/12/2021] [Accepted: 07/21/2021] [Indexed: 01/20/2023]
Abstract
AIM The purpose of this paper is to present the outcomes of three buccal mucosal graft (BMG) urethroplasty techniques in female patients with urethral strictures. METHODS We included all patients who had BMG urethroplasty for female urethral strictures (FUS) disease between January 2015 and June 2020. Patient age, comorbidities, stricture etiology, stricture length, the number of previous treatments, preoperative and postoperative uroflowmetry data, postvoid residual volumes, and the operation and postoperative course details were documented. RESULTS A total of 34 patients were included in this study. There were 8 patients in vaginal-sparing inlay BMG, 12 for ventral onlay BMG, and 14 for Aybek-Zumrutbas (AZ) technique groups. The mean age of the study population was 56.1 years. The length of urethral strictures varied between one and 4.5 cm. All patients had a previous history of endoscopic treatment or dilatations. The preoperative mean maximal flow rate (Qmax) was 6.9 ml/s. The median postoperative follow-up time was 24.6 months. Twelve months after surgery, the mean Qmax was 25 (range: 14-32) ml/s. There were no significant complications in any patients. The success rates were 83.3% for ventral onlay BMG, 87.5% for vaginal-sparing, and 100% for AZ technique. CONCLUSIONS All three BMG urethroplasty techniques applied in this study had a success rate of over 80% in a median follow-up of approximately 2 years. In females, urethroplasty with BMG provided high rates of cure, and the recently described two techniques (vaginal-sparing inlay BMG, and AZ technique) showed promise in FUS treatment.
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Affiliation(s)
- Ömer Gülpınar
- Department of Urology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ali Ersin Zumrutbas
- Department of Urology, School of Medicine, Pamukkale University, Denizli, Turkey
| | - Adem Sancı
- Department of Urology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Salih Bütün
- Department of Urology, School of Medicine, Pamukkale University, Denizli, Turkey
| | - Mehmet İlker Gokce
- Department of Urology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Zafer Aybek
- Department of Urology, School of Medicine, Pamukkale University, Denizli, Turkey
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Chua KJ, Mikhail M, Patel HV, Tabakin AL, Doppalapudi SK, Sterling J, SGR Tunuguntla H. Treatment of Urethral Stricture Disease in Women: Nonsystematic Review of Surgical Techniques and Intraoperative Considerations. Res Rep Urol 2021; 13:381-406. [PMID: 34189132 PMCID: PMC8232966 DOI: 10.2147/rru.s282651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/02/2021] [Indexed: 11/23/2022] Open
Abstract
Female urethral strictures are rare, but underdiagnosed pathologies that can cause voiding dysfunction. These strictures are best managed with open reconstruction, as endoscopic treatments have high rates of failure. A flap urethroplasty can be performed with vaginal, labial or bladder tissue. Meanwhile, graft urethroplasties can utilize vaginal, labial, buccal or lingual tissue. It is important to consider the etiology and type of stricture, local vascularity, and prior attempts at repair when selecting the type of repair. Multiple different techniques have been described with theoretical advantages to each one. While some studies have reviewed a few of the reconstructive techniques to treat female urethral strictures, no single study has accounted for each individual technique. In this review, we discuss techniques captured by a number of systematic reviews and other articles. We will herein focus on reviewing and describing each unique technique of reconstruction in the setting of female urethral stricture.
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Affiliation(s)
- Kevin J Chua
- Division of Urology, Department of Surgery, Rutgers, The State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA
| | - Mark Mikhail
- Division of Urology, Department of Surgery, Rutgers, The State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA
| | - Hiren V Patel
- Division of Urology, Department of Surgery, Rutgers, The State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA
| | - Alexandra L Tabakin
- Division of Urology, Department of Surgery, Rutgers, The State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA
| | - Sai Krishnaraya Doppalapudi
- Division of Urology, Department of Surgery, Rutgers, The State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA
| | - Joshua Sterling
- Division of Urology, Department of Surgery, Rutgers, The State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA
| | - Hari SGR Tunuguntla
- Division of Urology, Department of Surgery, Rutgers, The State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA
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Kühnke L, Fisch M, Vetterlein MW. [Contemporary management of urethral strictures in women]. Aktuelle Urol 2021; 52:260-267. [PMID: 33860480 DOI: 10.1055/a-1367-6565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Urethral strictures in women are rare and patients may present with varying symptoms. Hence, clinical guidelines regarding diagnostic algorithms and treatment approaches are scarce. Several small case series have presented results for several operative techniques, but patient cohorts are generally heterogeneous and relatively small, which hampers reliable comparability across institutions. The present narrative review aims to provide a contemporary overview of the literature regarding the clinical and therapeutical approach in women with urethral strictures.Iatrogenic reasons such as previous catheterization or genitourinary surgical interventions are the most common cause of female urethral strictures. In daily clinical routine, physical examination is the cornerstone for differential diagnosis and may aid in the decision to expand diagnostic workup by urethrocystoscopy, urethrography, or magnetic resonance imaging in case of suspected anatomic or morphologic cause of voiding disorder. Endoscopic approaches such as dilation or urethrotomy only provide short-term symptomatic relief and open urethroplasty is more commonly associated with durable long-term success. Regarding the surgical approach, there are comparable operative techniques at hand, using vaginal or labial flaps or oral mucosal grafts. Given the relative rarity of female urethral strictures with only small case series published, a statement regarding the superiority of one approach over the other is hardly possible. As for all rare disorders, multi-institutional, large patient series are needed to generate reliable evidence and to improve standards in the perioperative care of women with urethral strictures.
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Affiliation(s)
- Lennart Kühnke
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf
| | - Margit Fisch
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf
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Navarro-Galmes MA, Hernandez-Hernandez D, Padilla-Fernandez B, Castro-Diaz DM. Female Urethroplasty: Anterior Vaginal Wall Flap (Blandy Flap) - Simpler Tends to Be Better. Urol Int 2021; 106:313-316. [PMID: 33957637 DOI: 10.1159/000515994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/12/2021] [Indexed: 11/19/2022]
Abstract
Urethral stricture is a rare condition in women, representing a diagnostic challenge for the urologist. Its main etiology is traumatic or due to labor. Definitive treatment can be by means of dilations or urethroplasty using both local flaps and free grafts. In this study, we report the case of a patient with voiding symptoms during a period of 9 years after childbirth, despite an attempt of urethral dilation and chronic self-catheterization. The patient was finally diagnosed of a long distal urethral stricture, and she underwent urethroplasty with an anterior vaginal wall flap with satisfactory results. We take the opportunity to briefly review the diagnostic pathway in women with obstructive symptoms and the main female urethroplasty techniques.
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Affiliation(s)
| | | | - Barbara Padilla-Fernandez
- Urology Department, Hospital Universitario de Canarias, Tenerife, Spain.,Departamento de Cirugía, Universidad de la Laguna, La Laguna, Spain
| | - David Manuel Castro-Diaz
- Urology Department, Hospital Universitario de Canarias, Tenerife, Spain.,Departamento de Cirugía, Universidad de la Laguna, La Laguna, Spain
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Kulkarni SB, Bhat A, Bhatyal HS, Sharma GR, Dubey DD, Khattar N, Panda A, Dangi A, Batra VS, Joshi PM. The Urological Society of India Guidelines for the management of urethral stricture (Executive Summary). Indian J Urol 2021; 37:6-9. [PMID: 33850349 PMCID: PMC8033222 DOI: 10.4103/iju.iju_465_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Amilal Bhat
- Bhat's Hypospadias and Reconstructive Urology Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Hardev S Bhatyal
- Department of Peadiatric Urology, BLK Superspeciality Hospital, New Delhi, India
| | - Gyanendra R Sharma
- Department of Reconstructive Urology, Chitale Clinic Pvt. Ltd., Sholapur, Maharashtra, India
| | - Deepak D Dubey
- Department of Urology, Manipal Hospitals, Bengaluru, India
| | - Nikhil Khattar
- Department of Urology, Medanta - The Medicity, Gurugram, Haryana, India
| | - Arabind Panda
- Department of Urology, KIMS Hospitals, Secunderabad, Telangana, India
| | - Anujdeep Dangi
- Department of Reconstructive Urology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | | | - Pankaj M Joshi
- Kulkarni Reconstructive Urology Center, Pune, Maharashtra, India
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Lane GI, Gracely A, Uberoi P, Lee U, Smith AL, Anger JT, Theva D, DeLong J, Kowalik C, Padmanabhan P, Powell CR, Carmel ME, Clemens JQ, Cameron AP, Gupta P. Changes in patient reported outcome measures after treatment for female urethral stricture. Neurourol Urodyn 2021; 40:986-993. [PMID: 33719145 DOI: 10.1002/nau.24653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 11/07/2022]
Abstract
INTRODUCTION There is a paucity of patient reported outcome measure (PROM) data for women with urethral strictures. To address this gap, we aim to evaluate change in PROM among women who underwent surgery for a stricture. METHODS American Urological Association Symptom Index (AUA-SI) and Urogenital Distress Inventory (UDI-6) data from a multi-institutional retrospective cohort study of women treated for urethral stricture was assessed. RESULTS Fifty-seven women had either AUA-SS or UDI-6 and 26 had baseline and postoperative data for either. Most women underwent urethroplasty (77%) and the majority (73%) remained stricture free at median follow-up of 21 months (interquartile range [IQR] 7-37). The median baseline AUA-SI was 21 (IQR 12-28) and follow-up was 10 (IQR 5-24). After treatment, there was a median decrease of 12 (IQR -18 to -2) in AUA-SI (p = 0.003). The median AUA Quality of life (QOL) score at baseline and follow-up were 6 (IQR 4-6) and 3 (IQR 2-5), respectively. There was a median AUA-QOL improvement of 2 points (-5,0; p = 0.007) from a baseline 5 (unhappy) to 3 (mixed). Median UDI-6 scores were 50 (IQR 33-75) at baseline and 17 (IQR 0-39), at follow-up. After treatment, there was a median decrease of 19 (-31 to -11; p = 0.01). CONCLUSION Women with urethral strictures have severe lower urinary tract symptoms which improved after surgery. This study substantiates the claims that recognizing and treating women with urethral stricture disease greatly improves lower urinary tract symptoms and QOL.
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Affiliation(s)
- Giulia I Lane
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Alyssa Gracely
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Una Lee
- Virginia Mason, Seattle, Washington, USA
| | - Ariana L Smith
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Didi Theva
- Memorial Hospital Miramar, Miramar, Florida, USA
| | | | - Casey Kowalik
- Kansas University Medical Center, Kansas City, Kansas, USA
| | - Priya Padmanabhan
- Kansas University Medical Center, Kansas City, Kansas, USA.,Beaumont Hospital, Royal Oak, Michigan, USA
| | | | - Maude E Carmel
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - J Quentin Clemens
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Anne P Cameron
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Priyanka Gupta
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
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