Objective: Female urethral stricture (FUS) accounts for about 4%-13% of cases of female bladder outlet obstruction. FUS was and is still managed by repeated dilatations and/or direct visual internal urethrotomy. There are many alternative options for reconstruction like buccal or vaginal mucosal graft urethroplasty. Our aim was to describe the technique of dorsal onlay buccal mucosal graft (BMG) urethroplasty for FUS and present the outcomes.
Methods: Between January 2014 and December 2021, 37 patients who underwent dorsal onlay BMG urethroplasty were included in the study. Their pre-operative diagnosis was confirmed with uroflowmetry, micturating cystourethrogram, urethral calibration, and on table cystoscopy. Bladder catheter was removed after 2 weeks. Patients were followed up at 3 months, 6 months, 1 year, and then annually with urine analysis, uroflowmetry, and post-void residual assessment. We defined success as a maximum flow rate (Qmax) above 15 mL/s without the need for an additional instrumentation.
Results: The mean age of patients was 47.8 (standard deviation [SD] 11.3) years. Twenty patients had previously undergone urethral dilatations. The mean pre-operative Qmax was 7.79 (SD 3.73) mL/s. However, the mean Qmax improved to 23.20 (SD 8.25) mL/s after surgery. The mean post-void residual urine after surgery was 30.50 (SD 10.70) mL. This reduced from a mean value of 139.00 (SD 147.24) mL before surgery. The mean follow-up was 30.2 (SD 18.3, range 18-44) months. There was no post-operative incontinence. There were Clavien-Dindo Grade 1 complications in 6 out of 37 (16.2 %) patients during hospital stay. The only long-term complication was recurrence of stricture in 4 (10.8%) patients.
Conclusion: Dorsal onlay BMG urethroplasty in females is a safe, effective technique which can avoid repeated painful dilatations and multiple urethrotomies. One should always consider reconstruction in FUS without any fear of incontinence.
Dorsal, ventral, circumference in two patients each
6
17
100
0
Blaivas et al., 2012 [24]
Dorsal BMG onlay
3
25
100
0
Goel et al., 2014 [25]
Dorsal BMG onlay
8
15
63
0
Kowalik et al., 2014 [26]
Dorsal BMG onlay
4
24
100
0
Powell and Daniels, 2017 [27]
Dorsal BMG onlay
6
18.5
77
0
Hampson et al., 2019 [28]
Dorsal BMG onlay
39
32
77
0
Our study
Dorsal BMG onlay
37
30
89
0
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