Abstract
Introduction and hypothesis
We present our single institution experience with urethral reconstruction by using anterior U-shaped vaginal flap in female patients with urethral stricture.
Methods
Retrospective analysis was performed from March 2014 to April 2018. Fourteen patients with retention or severe voiding dysfunction and failed conservative management were enrolled. The demographic characteristics, vaginal examination, urodynamic parameters, and post-void residual urine (PVR) were reviewed. Patient Global Impression of Improvement (PGI-I) and American Urological Association (AUA) symptom index were completed pre- and post-operatively. In the dorsal lithotomy position, the Foley catheter was inserted and two parallel anterior vaginal walls incised around the urethral meatus. After dissection and the vaginal flaps were flipped up, the dorsal part of the urethra was incised vertically to pass the stricture and the distal end of the vaginal flap sutured to the proximal end of the urethra and inner part of the flap was tabularized over the larger size of Foley’s catheter. The second layer of the folded vaginal flap was sutured to native vagina.
Results
In all the patients, voiding LUTS improved or was cured. Average postoperative maximum urinary flow rate (Qmax) was 15.82 ± 3.27 ml/s and PVR was 27.35 ± 18.76 ml. During the follow-up, new onset of urgency and worsening urge incontinence were reported. Two patients suffered from stress urinary incontinence (SUI) after surgery, but in 1 patient it improved after 6 months and in the other due to the persistent SUI, trans-obturator tape (TOT) was applied after 12 months.
Conclusions
Most patients had a high level of satisfaction and improvement of lower urinary tract symptoms (LUTS). Hence, anterior vaginal flap urethroplasty is a safe and effective technique and may be utilized in the management of the initial phases of female urethral stricture after a multicenter prospective trial.
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References
Hoag N, Chee J. Surgical management of female urethral strictures. Transl Androl Urol. 2017;6(Suppl 2):S76–S80. https://doi.org/10.21037/tau.2017.01.20.
Faiena I, Koprowski C, Tunuguntla H. Female urethral reconstruction. J Urol. 2016;195(3):557–67. https://doi.org/10.1016/j.juro.2015.07.124.
Gormley EA. Vaginal flap urethroplasty for female urethral stricture disease. Neurourol Urodyn. 2010;29(Suppl 1):S42–5. https://doi.org/10.1002/nau.20814.
Blaivas JG, Groutz A. Bladder outlet obstruction nomogram for women with lower urinary tract symptomatology. Neurourol Urodyn. 2000;19(5):553–64.
Keegan KA, Nanigian DK, Stone AR. Female urethral stricture disease. Curr Urol Rep. 2008;9(5):419–23.
Smith AL, Ferlise VJ, Rovner ES. Female urethral strictures: successful management with long-term clean intermittent catheterization after urethral dilatation. BJU Int. 2006;98(1):96–9. https://doi.org/10.1111/j.1464-410X.2006.06206.x.
Blaivas JG, Santos JA, Tsui JF, Deibert CM, Rutman MP, Purohit RS, et al. Management of urethral stricture in women. J Urol. 2012;188(5):1778–82. https://doi.org/10.1016/j.juro.2012.07.042.
Romman AN, Alhalabi F, Zimmern PE. Distal intramural urethral pathology in women. J Urol. 2012;188(4):1218–23. https://doi.org/10.1016/j.juro.2012.06.016.
Rosenblum N, Nitti VW. Female urethral reconstruction. Urol Clin N Am. 2011;38(1):55–64, vi. https://doi.org/10.1016/j.ucl.2010.12.008.
Osman NI, Chapple CR. Contemporary surgical management of female urethral stricture disease. Curr Opin Urol. 2015;25(4):341–5. https://doi.org/10.1097/mou.0000000000000186.
Kowalik C, Stoffel JT, Zinman L, Vanni AJ, Buckley JC. Intermediate outcomes after female urethral reconstruction: graft vs flap. Urology. 2014;83(5):1181–5. https://doi.org/10.1016/j.urology.2013.12.052.
Blaivas JG. Vaginal flap urethral reconstruction: an alternative to the bladder flap neourethra. J Urol. 1989;141(3):542–5.
Tanello M, Frego E, Simeone C, Cosciani Cunico S. Use of pedicle flap from the labia minora for the repair of female urethral strictures. Urol Int. 2002;69(2):95–8. https://doi.org/10.1159/000065554.
Montorsi F, Salonia A, Centemero A, Guazzoni G, Nava L, Da Pozzo LF, et al. Vestibular flap urethroplasty for strictures of the female urethra. Impact on symptoms and flow patterns. Urol Int. 2002;69(1):12–6. https://doi.org/10.1159/000064353.
Onol FF, Antar B, Kose O, Erdem MR, Onol SY. Techniques and results of urethroplasty for female urethral strictures: our experience with 17 patients. Urology. 2011;77(6):1318–24. https://doi.org/10.1016/j.urology.2011.01.017.
Simonato A, Varca V, Esposito M, Carmignani G. Vaginal flap urethroplasty for wide female stricture disease. J Urol. 2010;184(4):1381–5. https://doi.org/10.1016/j.juro.2010.06.042.
Tsivian A, Sidi AA. Dorsal graft urethroplasty for female urethral stricture. J Urol. 2006;176(2):611–3; discussion 3. https://doi.org/10.1016/j.juro.2006.03.055.
Petrou SP, Rogers AE, Parker AS, Green KM, McRoberts JW. Dorsal vaginal graft urethroplasty for female urethral stricture disease. BJU Int. 2012;110(11 Pt C):E1090–5. https://doi.org/10.1111/j.1464-410X.2012.11233.x.
Onol FF, Onol SY, Tahra A, Boylu U. Ventral inlay labia minora graft urethroplasty for the management of female urethral strictures. Urology. 2014;83(2):460–4. https://doi.org/10.1016/j.urology.2013.09.020.
Rehder P, Glodny B, Pichler R, Exeli L, Kerschbaumer A, Mitterberger MJ. Dorsal urethroplasty with labia minora skin graft for female urethral strictures. BJU Int. 2010;106(8):1211–4. https://doi.org/10.1111/j.1464-410X.2010.09240.x.
Berglund RK, Vasavada S, Angermeier K, Rackley R. Buccal mucosa graft urethroplasty for recurrent stricture of female urethra. Urology. 2006;67(5):1069–71. https://doi.org/10.1016/j.urology.2005.12.010.
Hajebrahimi S, Bagheri A, Maroufi H, Mostafaie H. Anterior vaginal mucosal flap approach for female urethral reconstruction in patients with urethral stricture. https://www.ics.org/Abstracts/Publish/349/000680.pdf.
Barry MJ, Fowler FJ, O’Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK, et al. The American Urological Association symptom index for benign prostatic hyperplasia. J Urol. 1992;148(5, Part 1):1549–57. https://doi.org/10.1016/S0022-5347(17)36966-5.
Spilotros M, Malde S, Solomon E, Grewal M, Mukhtar BM, Pakzad M, et al. Female urethral stricture: a contemporary series. World J Urol. 2017;35(6):991–5. https://doi.org/10.1007/s00345-016-1947-7.
Romero-Maroto J, Verdu-Verdu L, Gomez-Perez L, Perez-Tomas C, Pacheco-Bru JJ, Lopez-Lopez A. Lateral-based anterior vaginal wall flap in the treatment of female urethral stricture: efficacy and safety. Eur Urol. 2018;73(1):123–8. https://doi.org/10.1016/j.eururo.2016.09.029.
Acknowledgements
This study is approved by the Ethics Committee of Research and the vice-chancellor of the Tabriz University of Medical Sciences (code:58480, IRCT20130306012728N5). Hereby, we would like to thank all women who participated in our study.
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Hajebrahimi, S., Maroufi, H., Mostafaei, H. et al. Reconstruction of the urethra with an anterior vaginal mucosal flap in female urethral stricture. Int Urogynecol J 30, 2055–2060 (2019). https://doi.org/10.1007/s00192-019-03910-3
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DOI: https://doi.org/10.1007/s00192-019-03910-3