Skip to main content

Advertisement

SpringerLink
Log in

Female urethral reconstruction: dorsal buccal mucosa graft onlay

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

Abstract

Purpose

Female urethral stricture (FUS) is an infrequent entity, but may cause significant morbidity. Despite a rising interest in recent years, there is still scarce published information. In this article, we review FUS with a special attention to the use of dorsal buccal mucosa grafts (DBMG).

Methods

A literature search was conducted summarizing information about etiology, anatomy, diagnosis, and management. A detailed description of our technique for DBMG urethroplasty is given, with a summary report of our experience and results.

Results

FUS accounts for about 1% of all women consulting for lower urinary tract symptoms (LUTS). Diagnosis is suspected in front of persistent LUTS suggestive of obstruction. Confirmatory tests are uroflowmetry, endoscopy, and urethrography; true anatomic strictures must be differentiated from functional or physiological obstructions. Initial management may include dilations, but recurrence is frequent. On the contrary, reconstructive surgery is highly efficient, with overall curative rates around 90%. For reconstruction, DBMG has gained popularity, because it would maintain intact the ventro-lateral urethral supporting structures, important for continence. The pathology of female strictures is unknown and neither the pre nor the intraoperative assessment allows determining the precise location and extent or the urethral damage; therefore, we advise extensive grafting of the entire urethra. Collected success of DBMG is 86% at a mean follow-up of 21 months. Morbidity is very low and de novo stress incontinence has not been reported.

Conclusions

Because of its many advantages, DMBG currently represents a prime choice for FUS reconstruction.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Abbreviations

LUTS:

Lower urinary tract symptoms

DBMG:

Dorsal buccal mucosa graft

PVR:

Post-void residual

UTIs:

Urinary tract infections

FUS:

Female urethral stricture

Q max :

Maximum urinary flow

Pdet@Qmax :

Detrusor pressure at the moment of maximum urinary flow

References

  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  Google Scholar 

  2. 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  Google Scholar 

  3. Carr LK, Webster GD (1996) Bladder outlet obstruction in women. Urol Clin N Am 23:385–391

    Article  CAS  Google Scholar 

  4. West C, Lawrence A (2018) Female urethroplasty: contemporary thinking. World J Urol. https://doi.org/10.1007/s00345-018-2564-4

    Article  PubMed  Google Scholar 

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

    Article  Google Scholar 

  6. 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  Google Scholar 

  7. Macura KJ, Genadry R, Borman TL et al (2004) Evaluation of the female urethra with intraurethral magnetic resonance imaging. J Magn Reson Imaging 20:153–159

    Article  Google Scholar 

  8. Brannan D (1951) Stricture of the female urethra. J Urol 66:242–253

    Article  CAS  Google Scholar 

  9. Powell NB, Powell EB (1949) The female urethra: a clinico-pathological study. J Urol 61:557–570

    Article  CAS  Google Scholar 

  10. Smith AL, Ferlise VJ, Rovner ES (2006) Female urethral strictures: successful management with long-term clean intermittent catheterization after urethral dilatation. BJU Int 98:96–99

    Article  Google Scholar 

  11. Keegan KA, Nanigian DK, Stone AR (2008) Female urethral stricture disease. Curr Urol Rep 9:419–423

    Article  Google Scholar 

  12. Hinman F (2012) Female genital tract and urethra. In: MacLennan GT (ed) Hinman’s atlas of urosurgical anatomy, 2nd ed. Elsevier, Philadelphia, pp 287–297

    Google Scholar 

  13. Gormley EA (2010) Vaginal flap urehtroplasty for female urethral stricture disease (2010). Neurourol Urodyn 29:S42

    Article  Google Scholar 

  14. Defreitas GA, Zimmern PE, Lemack GE et al (2004) Refining diagnosis of anatomic female bladder outlet obstruction (comparison of pressure-flow study parameters in clinically obstructed women with those of normal controls). Urology 64:675

    Article  Google Scholar 

  15. Kuo HC (2004) Urodynamic parameters for the diagnosis of bladder outlet obstruction in women. Urol Int 72:46

    Article  Google Scholar 

  16. Solomon E, Yasmin H, Jenks J, Pakzad M, Hamid R, Ockrim J et al (2014) MP76-02 The development and validation of a new nomogram for diagnosis bladder outlet obstruction in women. J Urol 191(4):e882

    Google Scholar 

  17. Faiena I, Koprowski Ch, Tunuglunta H (2016) Female urethral reconstruction: a review. J Urol 195:1–11

    Article  Google Scholar 

  18. Osman N, Chapple Ch (2015) Contemporary surgical management of female urethral stricture disease. Curr Opin Urol 25:341–345

    PubMed  Google Scholar 

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

    Article  Google Scholar 

  20. Sharma GK, Pandey A, Bansal H et al (2010) Dorsal onlay lingual mucosal graft urethroplasty for urethral strictures in women. BJU Int 105:1309–1312

    Article  Google Scholar 

  21. 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  Google Scholar 

  22. 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 

  23. 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 

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

    Article  Google Scholar 

  25. Castillo OA, Sepulveda F, Feria-Flores MA (2011) Urethroplasty with dorsal oral mucosa graft in female urethral stenosis [in Spanish]. Actas Urol Esp 35:246–249

    Article  CAS  Google Scholar 

  26. 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  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Urology Service, Hospital del Trabajador, Ramón Carnicer 185, Santiago, Chile

    Reynaldo G. Gomez & Rodrigo A. Campos

  2. School of Medicine, Andres Bello University, Santiago, Chile

    Reynaldo G. Gomez

  3. Urology Service, Hospital Regional, Valdivia, Chile

    Fernando J. Segura

  4. School of Medicine, Universidad Austral de Chile, Valdivia, Chile

    Fernando J. Segura

  5. Service of Urology, Hospital Dr. Sótero del Río, Santiago, Chile

    Alvaro Saavedra

  6. Faculty of Medicine, P. Universidad Católica de Chile, Santiago, Chile

    Alvaro Saavedra

  7. Service of Urology, Clinica Alemana de Santiago, Santiago, Chile

    Alvaro Saavedra

Authors
  1. Reynaldo G. Gomez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fernando J. Segura
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alvaro Saavedra
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rodrigo A. Campos
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

RGG: protocol/project development, data collection and management, data analysis, manuscript writing/editing. FJS: protocol/project development, manuscript writing/editing. AS: data analysis, manuscript writing/editing. RAC: data collection and management.

Corresponding author

Correspondence to Reynaldo G. Gomez.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

This is a retrospective study, therefore, informed consent was not possible.

Ethical approval

This is a retrospective study performed in accordance with the ethical standards of the institutional research committee of Hospital del Trabajador and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gomez, R.G., Segura, F.J., Saavedra, A. et al. Female urethral reconstruction: dorsal buccal mucosa graft onlay. World J Urol 38, 3047–3054 (2020). https://doi.org/10.1007/s00345-019-02958-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-019-02958-6

Keywords

Search

Navigation