Skip to main content


Log in

Female urethroplasty: contemporary thinking

  • Topic Paper
  • Published:
World Journal of Urology Aims and scope Submit manuscript



Female urethral stricture disease is a rare entity. To date, its diagnosis and treatment have been poorly studied, with small numbers, and variable definitions of success. With growing interest in this area of reconstructive urology, there is an increased number of surgical techniques. In this article, we review current trends, definitions, etiologies and surgical techniques available for management of FUSD.


We completed a review of publications in: English; Pubmed, and Google scholar. Key words identified for review were, female urethra stricture, female urethroplasty and female urethral dilation, female pelvic fracture, and female urethral reconstruction. Papers were reviewed, and references of relevant papers reviewed.


Iatrogenic injury is the most common cause of female urethral stricture disease. Assessment requires a thorough patient history, examination and either flexible cystoscopy and/or fluoroscopic urodynamics to determine the most appropriate surgical approach for stricture repair. Multiple open urethroplasty techniques are described with various grafts and flaps, with good medium-term success. Minimally invasive techniques remain well-employed but have poor long-term success, with increased failure with multiple attempts at treatment.


Female urethral stricture disease is a complex clinical entity that requires a measured and thorough evaluation. Individualized approach should be undertaken reviewing the patient’s symptoms, the stricture’s etiology, surrounding vaginal tissue health and stricture location. Promising medium-term success rates with vaginal flaps and buccal mucosal graft urethroplasty have been reported, with disappointing long-term results from repeated urethral dilation. Further research comparing techniques and defining successful long-term outcomes is required.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others


  1. Spilotros M, Malde S, Solomon E, Grewal M, Mukhtar BM, Pakzad M, Hamid R, Ockrim JL, Greenwell TJ (2017) Female urethral stricture: a contemporary series. World J Urol 35:991–995

    Article  CAS  PubMed  Google Scholar 

  2. Smith AL, Ferlise VJ, Rovner ES (2009) Female urethral strictures: successful management with long-term clean intermittent catheterization after urethral dilatation. BJU Int 98:96–99

    Article  Google Scholar 

  3. Osman NI, Mangera A, Chapple CR (2013) A systematic review of surgical techniques used in the treatment of female urethral stricture. Eur Urol 64:965–973

    Article  PubMed  Google Scholar 

  4. Faiena I, Koprowski C, Tunuguntla H (2016) Female urethral reconstruction. J Urol 195:557–567

    Article  PubMed  Google Scholar 

  5. Gormley EA (2010) Vaginal flap urethroplasty for female urethral stricture disease. Neurourol Urodyn 29:S42–S45

    Article  PubMed  Google Scholar 

  6. Hoag N, Chee J (2017) Surgical management of female urethral strictures. Transl Adrol Urol 6(Suppl 2):S76–S80

    Article  Google Scholar 

  7. Osman NI, Chapple CR (2015) Contemporary surgical management of female urethral stricture disease. Curr Opin Urol 25:341–345

    PubMed  Google Scholar 

  8. Blaivas JG, Satos JA, Tsui JF et al (2012) Management of urethral stricture in women. J Urol 188:1778–1782

    Article  PubMed  Google Scholar 

  9. Petrou SP, Rogers AE, Parker AS, Green KM, McRoberts JW (2012) Dorsal vaginal graft urethroplasty for female urethral stricture disease. BJU Int 110:E1090–E1095

    Article  PubMed  Google Scholar 

  10. Anast J, Brandes SB, Klutke C (2008) Female urethral reconstruction In: Brandes SB (ed) Urethral reconstructive surgery, Humana Press, Totowa, p 303

    Chapter  Google Scholar 

  11. Romman AN, Alhalabi F, Zimmerman PE (2012) Distal intramural urethral pathology in women. J Urol 188:1218–1223

    Article  PubMed  Google Scholar 

  12. Popat S, Zimmern P (2016) Long-term management of luminal urethral stricture in women. Int Urogynaecol 27:1735–1741

    Article  Google Scholar 

  13. Rosenblum N, Nitti VW (2011) Female urethral reconstruction. Urol Clin North Am 38:55–64

    Article  PubMed  Google Scholar 

  14. Montorsi F, Salonia A, Centemero A et al (2002) Vestibular flap urethroplasty for strictures of the female urethra—impact on symptoms and flow patterns. Urol Int 69:12–16

    Article  PubMed  Google Scholar 

  15. Simonato A, Varca V, Esposito M, Carmignani G (2010) Vaginal flap urethroplasty for wide female stricture disease. J Urol 184:1381–1385

    Article  PubMed  Google Scholar 

  16. Onol FF, Atar B, Osman K, Erdem MR, Onol SY (2011) Techniques and results of urethroplasty for female urethral strictures: our experience with 17 patients. Urology 77:1318–1324

    Article  PubMed  Google Scholar 

  17. Tanello M, Frego E, Simeone C, Cosciani Cunico S (2002) Use of pedicle flap from the labia minora for the repair of female urethral strictures. Urol Int 69:95–98

    Article  CAS  PubMed  Google Scholar 

  18. Falandry L, Xie D, Liang Z, Seydou M, Alphonsi R (1999) Utilisation of a pedicled labial flap, single or double face, for the management of post-obstetric urethral damage. J Gynecol Obstet Biol Reprod (Paris) 28:151–161

    CAS  Google Scholar 

  19. Xu YM, Sa YL, Fu Q, Zhang J, Xie H, Jin SB (2009) Transpubic access using pedicle tubularised labial urethroplasty for the treatment of urethral strictures associated with urethrovaginal fistulas secondary to pelvic fracture. Eur Urol 56:193–200

    Article  PubMed  Google Scholar 

  20. Onol FF, Onol SY, Tahra A, Boylu U (2014) Ventral inlay labia minora graft urethroplasty for the management of female urethral strictures. Urology 83:460–464

    Article  PubMed  Google Scholar 

  21. Rehder P, Glodny B, Pichler R, Exeli L, Kerschbaumer A, Mitterberger MJ (2010) Dorsal urethroplasty with labia minor skin graft for female urethral strictures. BJU Int 106:1211–1214

    Article  PubMed  Google Scholar 

  22. Gozzi C, Roosen A, Bastian PJ, Karl A, Stief C, Tritschler S (2010) Volar only urethroplasty for reconstruction of female urethra in recurrent stricture disease. BJU Int 107:1964–1966

    Article  PubMed  Google Scholar 

  23. Tsivian A, Sidi A (2006) Dorsal graft urethroplasty for female urethral stricture. J Urol 176:611–613

    Article  PubMed  Google Scholar 

  24. Migliari R, Leone P, Berdondini E, De Angelis M, Barbagli G, Palminteri E (2006) Dorsal buccal mucosal graft urethroplasty for female urethral strictures. J Urol 176:1473–1476

    Article  PubMed  Google Scholar 

  25. Berglund RK, Vasavada S, Angermeier K, Rackley R (2006) Buccal mucosa graft urethroplasty for recurrent stricture of female urethra. Urology 67:1069–1071

    Article  PubMed  Google Scholar 

  26. Sharma GK, Pandey A, Bansal H, Swain S, Das SK, Trivedi S, Dwivedi US, Singh PB (2009) Dorsal onlay lingual mucosal graft urethroplasty for urethral strictures in women. BJU Int 105:1309–1312

    Article  PubMed  Google Scholar 

  27. Castillo OA, Sepulveda F, Feria-Flores MA (2009) Urethroplasty with dorsal oral mucosa graft in female urethral stenosis. Actas Urol Esp 35:246–249 (in Spanish)

    Article  Google Scholar 

  28. Kowalik C, Stoffel JT, Zinman L, Vanni AJ, Buckley JC (2014) Intermediate outcomes after female urethral reconstruction: graft vs flap. Urology 83:1181–1185

    Article  PubMed  Google Scholar 

  29. Goel A, Paul S, Dalela D, Pushpalata S, Narayan S, Singh V (2014) Dorsal onlay buccal mucosal graft urethroplasty in female urethral stricture disease: a single-centre experience. Int Urogynaecol J 25:525–530

    Article  Google Scholar 

  30. Powell CR, Daniels D (2017) Dorsal onlay buccal urethroplasty in the female is associated with high quality of life using validated lower urinary tract symptom instruments. Urol Pract 4:48–53

    Article  Google Scholar 

  31. Hoag N, Gani J, Chee J (2016) Vaginal-sparing ventral buccal mucosal graft urethroplasty for female urethral stricture: a novel modification of surgical technique. Investig Clin Urol 57:298–302

    Article  PubMed  PubMed Central  Google Scholar 

  32. Ackerman AL, Blaivas J, Anger JT (2010) Female urethral reconstruction. Curr Bladder Dysfunct Rep 5:225–232

    Article  PubMed  PubMed Central  Google Scholar 

  33. Tanagho EA (1976) Urethrosphincteric reconstruction for congenitally absent urethra. J Urol 116:237–242

    Article  CAS  PubMed  Google Scholar 

  34. Hemal AK, Dorairaja L, Gupta NP (2000) Posttraumatic complete and partial loss of urethra with pelvic fracture in girls: an appraisal of management. J Urol 163:282–287

    Article  CAS  PubMed  Google Scholar 

  35. Flisser AJ, Blaivas JG (2003) Outcome of urethral reconstructive surgery in a series of 74 women. J Urol 169:2246–2249

    Article  PubMed  Google Scholar 

  36. Versteegden LRM, de Jonge PKJD, IntHout J et al (2017) Tissue engineering of the urethra: a systematic review and meta-analysis of preclinical and clinical studies. Eur Urol 72(4):594–606

    Article  PubMed  Google Scholar 

  37. Davis NF, Cunnane EM, O’Brien FJ, Mulvihill JJ, Walsh MT (2018) Tissue engineered extracellular matrices (ECMs) in urology: evolution and future directions. Surgeon 16(1):55–65

    Article  CAS  PubMed  Google Scholar 

  38. Mantovani F, Trinchieri A, Castelnuovo C, Romano AL, Pisani E (2003) Reconstructive urology using porcine acellular matrix. Eur Urol 44(5):600–602

    Article  PubMed  Google Scholar 

  39. Ansari S, Karram M (2017) Two cases of female urethral reconstruction with acellular porcine urinary bladder matrix. Int Urogynecol J 28:1257–1260

    Article  PubMed  Google Scholar 

  40. Rutherford AJ, Hinshaw K, Essenhigh DM, Neal DE (1988) Urethral dilatation compared with cystoscopy alone in the treatment of women with recurrent frequency and dysuria. BJU Int 61:500–504

    Article  CAS  Google Scholar 

  41. Santucci RA, Payne CK, Anger JT, Saigal CS (2008) Office dilatation of the female urethra: a quality of care problem in the field of urology. J Urol 180:2068–2075

    Article  PubMed  PubMed Central  Google Scholar 

  42. Al Taweel W, Seyam R (2015) Visual internal urethrotomy for adult male stricture has poor long term results. Adv Urol 2015:656459

    Article  PubMed  PubMed Central  Google Scholar 

  43. Santucci R, Eisenberg L (2010) Urethrotomy has a much lower success rate than previously reported. J Urol 183(5):1859–1862

    Article  PubMed  Google Scholar 

  44. Radwan MH, Abou Farha MO, Soliman MG et al (2013) Outcome of female urethral reconstruction: a 12-year experience. WJU 3:991–995

    Google Scholar 

Download references


Jacinta Townsend edited the manuscript.

Author information

Authors and Affiliations



CW and AL: Protocol/project development. CW and AL: Data collection or management. CW and AL: Data analysis. CW and AL: Manuscript writing/editing.

Corresponding author

Correspondence to A. Lawrence.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

West, C., Lawrence, A. Female urethroplasty: contemporary thinking. World J Urol 37, 619–629 (2019).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: