MB ChB, MD, FRCS(Urol) University College London Hospital
Introduction: Female urethral stricture (FUS) is rare. Urethroplasty is becoming increasingly popular however there is little to guide choice of technique as all series to date contain small numbers with limited follow-up. We report the medium to long-term outcomes of ventral-onlay buccal mucosa graft substitution urethroplasty (VOBMGSU) in treating FUS. Methods: A retrospective review of a prospectively acquired database of 52 consecutive women (median age 51 years, range 31-71) with urethral stricture having VOBMGSU since June 2012 and a median follow up 38.2 months, range 8.1-111.9). Data was analysed for stricture recurrence, change in peak free flow rate (Qmax), post-void residuals (PVR) and Patient Global Impression of Improvement (PGII) using a 7-point Likert scale where 1 = very much better and 7 = very much worse). Short and longer-term complications of surgery were noted. Persistent or de-novo lower urinary tract symptoms (LUTS) were investigated to delineate their cause – and this is detailed. Statistical analysis was performed with the Wilcoxon signed rank test, Students T Test and Mann-Whitney U Test. Results: At last follow-up 46/52 (88.5%) of women were stricture free. Mean Qmax significantly improved from 6 ml/s (range 0-24) to 14 ml/s (range 5- 31) (p < 0.05). Mean PVR significantly reduced from 112mls (range 0-609) to 38 mls (range 9-86) (p < 0.05). Short and longer-term complication rates were low. 1/48(2.1%) patients developed mild de novo SUI, which settled with conservative measures by 6 months post urethroplasty. Frequency persisted in 6/52 (9.7%) and was managed with intravesical Botox in 2 and Sacral Neuromodulation in 1. Stricture recurrence was managed by meatotomy in 1, meatal dilatation in 2, redo-VOBMG urethroplasty in 2 and vaginal flap meatoplasty in 1 with resolution of stricture in 5. Median PGII at 12 months post VOBMG urethroplasty was 1 (1-4) and this was maintained at 36 months post-surgery. Conclusions: Medium term results in the largest series of VOBMG female urethroplasty to date are excellent with stricture free rates of 88.5%, median PGII of 1 and significantly improved Qmax and PVRs. SOURCE OF Funding: Nil
