MB ChB, MD, FRCS(Urol) University College London Hospital
Introduction: Female urethral stricture (FUS) is rare. We have assessed the history, imaging and urodynamic characteristics of all women seeking urethroplasty for recurrent symptomatic strictures. Methods: A retrospective review of 63 consecutive women (median age 50.5 years, range 25-71) with recurrent or refractory FUS undergoing urethroplasty since June 2012. Data was analysed for symptom profile, aetiology and previous therapy. MRI, videourodynamic (VUDS) and examination findings provided stricture length and site. Results: Median duration of symptoms was 60 months(range 24-456). The commonest symptoms were poor flow 61(97%), frequency 48(76%), nocturia 46(73%), urgency 44(70%), recurrent UTI 41(65%) and urethral pain 40(63%). The commonest causes of FUS are, unknown in 37(59.7%), urethral instrumentation/catheterisation in 7(11.1%), urethral diverticulum excision in 4(6%), radiotherapy in 3(4.7%), none relaxing sphincter in 3(4.7%) and lichen planus in 2(3.2%). The women had had a median of 5 previous urethral dilatations(range 0-33). 38(60%) had been performing ISC for a mean of 24 months(range 6-120) and 31(82%) found it painful. Pre-operative MRI pelvis was performed in 56(89%) and revealed a concentrically thickened urethra in 35(63%), urethral diverticulum in 4(6%), an absent/fibrotic urethra in 4(6%), and no abnormalities in 13(21%). Pre-operative VUDS were performed in 57(90%). Bladder outflow obstruction (BOO) was seen in 56(98%). Preoperatively median Qmax was 5 mls/s (range 0-24), median Pdet Q max was 70 cmH2O (range 0-165) and median Solomon-Greenwell BOOIf was 51.4 (range -24.2-156.2) (where BOOIf>5 =>50% chance of BOO). Other findings included detrusor overactivity in 22(39%) and stress urinary incontinence in 7(12%). Median stricture length was 2.0cm (range 0.5-4.0cm) and the commonest sites were mid-distal in 20(32%) and distal in 19 (30%). 53(84%) had ventral onlay buccal mucosal graft urethroplasty, 6(10%) had ventral vaginal flap urethroplasty, 2(3%) had ventral onlay labial minora flap urethroplasty and 1(1.5%) had a ventral vaginal graft urethroplasty – with stricture free status in 55(87%) at last follow-up (median 39 months, range 4-112). Conclusions: Poor flow is present in almost all women with FUS. The majority will also have irritative LUTS, recurrent UTIs and urethral pain. VUDS and MRI are useful pre-operatively to characterise the stricture. Definitive treatment with urethroplasty should be considered earlier once endoscopic management has failed. SOURCE OF Funding: Nil
