Casey Kowalik1, John T Stoffel2, Leonard Zinman3, Alex J Vanni3, Jill C Buckley4. 1. Institute of Urology, Lahey Hospital & Medical Center, Burlington, MA. Electronic address: casey.kowalik@gmail.com. 2. Department of Urology, University of Michigan Health System, Ann Arbor, MI. 3. Institute of Urology, Lahey Hospital & Medical Center, Burlington, MA. 4. Department of Urology, University of California San Diego Health System, San Diego, CA.
Abstract
OBJECTIVE: To evaluate the outcomes of women after urethral reconstruction with a vaginal flap urethroplasty (VFU) or dorsal buccal mucosal graft (BMG). METHODS: We retrospectively identified 10 women undergoing urethral reconstruction between February 2007 and October 2012. All patients had evidence of urethral stricture on cystoscopy and/or urodynamic study indicating bladder outlet obstruction. Recurrent stricture was defined using the same criteria. Follow-up included urethral calibration (>16F), symptom assessment, voiding cystourethrogram, and cystoscopy when there was difficulty voiding or symptoms recurred. RESULTS: Mean age was 49 years (range, 32-74). The indication for urethral reconstruction was urethral stricture in 9 patients. One woman had a traumatic 2-cm ventral urethral laceration associated with a pelvic fracture. Location was mid in 6 and distal in 4 women. Average stricture length was 1.25 cm (range, 0.2-2). All patients with urethral stricture had previously undergone multiple urethral dilations. There were no major postoperative complications. Two patients undergoing VFU had a recurrent stricture requiring dilation. No patients undergoing dorsal BMG had a recurrent stricture. CONCLUSION: Female urethral reconstruction, either VFU or dorsal BMG, is a safe and successful procedure that should be offered to women with urethral strictures. The dorsal BMG approach is well tolerated and results are promising, but longer-term follow-up is needed. Women should be offered urethral reconstruction as a definitive management option rather than repeated urethral dilations.
OBJECTIVE: To evaluate the outcomes of women after urethral reconstruction with a vaginal flap urethroplasty (VFU) or dorsal buccal mucosal graft (BMG). METHODS: We retrospectively identified 10 women undergoing urethral reconstruction between February 2007 and October 2012. All patients had evidence of urethral stricture on cystoscopy and/or urodynamic study indicating bladder outlet obstruction. Recurrent stricture was defined using the same criteria. Follow-up included urethral calibration (>16F), symptom assessment, voiding cystourethrogram, and cystoscopy when there was difficulty voiding or symptoms recurred. RESULTS: Mean age was 49 years (range, 32-74). The indication for urethral reconstruction was urethral stricture in 9 patients. One woman had a traumatic 2-cm ventral urethral laceration associated with a pelvic fracture. Location was mid in 6 and distal in 4 women. Average stricture length was 1.25 cm (range, 0.2-2). All patients with urethral stricture had previously undergone multiple urethral dilations. There were no major postoperative complications. Two patients undergoing VFU had a recurrent stricture requiring dilation. No patients undergoing dorsal BMG had a recurrent stricture. CONCLUSION: Female urethral reconstruction, either VFU or dorsal BMG, is a safe and successful procedure that should be offered to women with urethral strictures. The dorsal BMG approach is well tolerated and results are promising, but longer-term follow-up is needed. Women should be offered urethral reconstruction as a definitive management option rather than repeated urethral dilations.
Authors: Lindsay A Hampson; Jeremy B Myers; Alex J Vanni; Ramón Virasoro; Thomas G Smith; Leandro Capiel; Jason Chandrapal; Bryan B Voelzke Journal: Transl Androl Urol Date: 2019-03
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