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Female Urethral Strictures: Review of Diagnosis, Etiology, and Management

  • Lower Urinary Tract Symptoms & Voiding Dysfunction (J Sandhu, Section Editor)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

In this review, we describe the incidence, diagnosis, and management of urethral strictures in women.

Recent Findings

Definitive repair of urethral strictures in women traditionally utilizes vaginal and labial flaps. Oral mucosal buccal graft urethroplasty also has high success rates, with larger series demonstrating feasibility and durability.

Summary

Urethral strictures in women are very rare. When they do occur, they are often difficult to diagnose, requiring a high index of suspicion. Women with urethral strictures often present with symptoms of obstructed urinary flow, such as incomplete emptying, straining, and elevated postvoid residual. First line, minimally invasive treatment consists of urethral dilation and urethrotomy, though urethrotomy is rarely performed. Repeat urethral dilation has low success rates compared with urethroplasty, which is a more definitive treatment.

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References

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  1. Carr LK, Webster GD. Bladder outlet obstruction in women. Urol Clin North Am. 1996;23(3):385–91.

    Article  CAS  Google Scholar 

  2. Groutz A, Blaivas JG, Chaikin DC. Bladder outlet obstruction in women: definition and characteristics. Neurourol Urodyn. 2000;19(3):213–20.

    Article  CAS  Google Scholar 

  3. Kuo HC. Videourodynamic characteristics and lower urinary tract symptoms of female bladder outlet obstruction. Urology. 2005;66(5):1005–9.

    Article  Google Scholar 

  4. Osman NI, Chapple CR. Contemporary surgical management of female urethral stricture disease. Curr Opin Urol. 2015;25(4):341–5.

    PubMed  Google Scholar 

  5. •• Faiena I, Koprowski C, Tunuguntla H. Female urethral reconstruction. J Urol. 2016;195(3):557–67 A review article on female urethral reconstruction, which discusses techniques and methods of female urethral reconstruction.

    Article  Google Scholar 

  6. Osman NI, Mangera A, Chapple CR. A systematic review of surgical techniques used in the treatment of female urethral stricture. Eur Urol. 2013;64(6):965–73.

    Article  Google Scholar 

  7. •• 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 A retrospective study of 26 women with urethral stricture. In this study, urethral dilation, urethotomy, meatoplasty, and urethroplasty were used to treat urethral strictures. Of treatments, patients treated with buccal mucosal graft urethroplasty had the most durable result.

    Article  CAS  Google Scholar 

  8. Keegan KA, Nanigian DK, Stone AR. Female urethral stricture disease. Curr urol rep. 2008;9(5):419–23.

    Article  Google Scholar 

  9. 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.

    Article  Google Scholar 

  10. •• Hampson LA, Myers JB, Vanni AJ, Virasoro R, Smith TG 3rd, Capiel L, et al. Dorsal buccal graft urethroplasty in female urethral stricture disease: a multi-center experience. Transl androl and urol. 2019;8(Suppl 1):S6–s12 Largest retrospective study of buccal mucosal grafts for female urethral stricture. In this review, most women had undergone prior stricture-related procedure, 18% of individuals had complications within 30 days, and 23% had stricture recurrence.

    Article  Google Scholar 

  11. J. Anast SBB, C. Klutke. Female urethral reconstruction: Humana Press; 2008.

  12. 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.

    Article  Google Scholar 

  13. Blaivas JG, Sandhu J. Urethral reconstruction after erosion of slings in women. Curr Opin Urol. 2004;14(6):335–8.

    Article  Google Scholar 

  14. Flisser AJ, Blaivas JG. Outcome of urethral reconstructive surgery in a series of 74 women. J Urol. 2003;169(6):2246–9.

    Article  Google Scholar 

  15. Perry MO, Husmann DA. Urethral injuries in female subjects following pelvic fractures. J Urol. 1992;147(1):139–43.

    Article  CAS  Google Scholar 

  16. Pugliese JM, Morey AF, Peterson AC. Lichen sclerosus: review of the literature and current recommendations for management. J Urol. 2007;178(6):2268–76.

    Article  Google Scholar 

  17. Desai S, Libertino JA, Zinman L. Primary carcinoma of the female urethra. J Urol. 1973;110(6):693–5.

    Article  CAS  Google Scholar 

  18. Indudhara R, Vaidyanathan S, Radotra BD. Urethral tuberculosis. Urol Int. 1992;48(4):436–8.

    Article  CAS  Google Scholar 

  19. Waterloos M, Verla W. Female urethroplasty: a practical guide emphasizing diagnosis and surgical treatment of female urethral stricture disease. Biomed Res Int. 2019;2019:6715257.

    Article  Google Scholar 

  20. Gormley EA. Vaginal flap urethroplasty for female urethral stricture disease. Neurourol Urodyn. 2010;29(Suppl 1):S42–5.

    Article  Google Scholar 

  21. Defreitas GA, Zimmern PE, Lemack GE, Shariat SF. Refining diagnosis of anatomic female bladder outlet obstruction: comparison of pressure-flow study parameters in clinically obstructed women with those of normal controls. Urology. 2004;64(4):675–9 discussion 9-81.

    Article  Google Scholar 

  22. Bradley CS, Rovner ES. Urodynamically defined stress urinary incontinence and bladder outlet obstruction coexist in women. J Urol. 2004;171(2 Pt 1):757–60 discussion 60-1.

    Article  CAS  Google Scholar 

  23. Elsayes KM, Mukundan G, Narra VR, Abou El Abbass HA, Prasad SR, Brown JJ. Endovaginal magnetic resonance imaging of the female urethra. J Comput Assist Tomogr. 2006;30(1):1–6.

    Article  Google Scholar 

  24. Theisen KM, Kadow BT, Rusilko PJ. Three-dimensional imaging of urethral stricture disease and urethral pathology for operative planning. Curr urol rep. 2016;17(8):54.

  25. Chou CP, Huang JS, Wu MT, Pan HB, Huang FD, Yu CC, et al. CT voiding urethrography and virtual urethroscopy: preliminary study with 16-MDCT. AJR Am J Roentgenol. 2005;184(6):1882–8.

    Article  Google Scholar 

  26. Standring S. In: Standring S, editor. Gray’s anatomy: the anatomical basis of clinical practice. New York: Elsevier Limited; 2016.

    Google Scholar 

  27. Macura KJ, Genadry R, Borman TL, Mostwin JL, Lardo AC, Bluemke DA. Evaluation of the female urethra with intraurethral magnetic resonance imaging. Journal of magnetic resonance imaging : J Magn Reson Imagin. 2004;20(1):153–9.

    Article  Google Scholar 

  28. A.P. Cameron CL-G, E.J.McGuire. Pubovaginal fascial slings: Lippincott Williams and Wilkins.

  29. Romman AN, Alhalabi F, Zimmern PE. Distal intramural urethral pathology in women. J Urol. 2012;188(4):1218–23.

    Article  Google Scholar 

  30. 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.

    Article  Google Scholar 

  31. Berglund RK, Vasavada S, Angermeier K, Rackley R. Buccal mucosa graft urethroplasty for recurrent stricture of female urethra. Urology. 2006;67(5):1069–71.

    Article  Google Scholar 

  32. Simonato A, Varca V, Esposito M, Carmignani G. Vaginal flap urethroplasty for wide female stricture disease. J Urol. 2010;184(4):1381–5.

    Article  Google Scholar 

  33. 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.

    Article  CAS  Google Scholar 

  34. Mukhtar BMB, Spilotros M, Malde S, Greenwell TJ. Ventral-onlay buccal mucosa graft substitution urethroplasty for urethral stricture in women. BJU Int. 2017;120(5):710.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, University of California, San Francisco, San Francisco, CA, USA

    Nnenaya Agochukwu-Mmonu, Sudarshan Srirangapatanam, Andrew Cohen & Benjamin Breyer

  2. Departments of Urology and Epidemiology and Biostatistics, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA

    Benjamin Breyer

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  1. Nnenaya Agochukwu-Mmonu
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Correspondence to Benjamin Breyer.

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Nnenaya Agochukwu-Mmonu, Sudarshan Srirangapatanam, Andrew Cohen, and Benjamin Breyer each declare no potential conflicts of interest.

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Agochukwu-Mmonu, N., Srirangapatanam, S., Cohen, A. et al. Female Urethral Strictures: Review of Diagnosis, Etiology, and Management. Curr Urol Rep 20, 74 (2019). https://doi.org/10.1007/s11934-019-0933-1

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  • DOI: https://doi.org/10.1007/s11934-019-0933-1

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