NEUROUROLOGY & FEMALE UROLOGY

Dorsal Graft Urethroplasty for Female Urethral Stricture
Tsivian A, Sidi AA
Department of Urologic Surgery, Wolfson Medical Center, Holon, Tel Aviv University, Israel
J Urol. 2006; 176: 611-3

• Purpose: Urethral strictures in females are uncommon, and treatment options and outcome are not well-defined with scanty reports. We describe a new method of urethroplasty for the repair of female urethral stricture.
• Materials and Methods: Three 60-year-old females, each with a history of recurrent urinary tract infections and obstructive voiding symptoms due to urethral stricture, underwent urethroplasty with a dorsal vaginal or buccal mucosal graft. The dorsal aspect of the distal urethra was dissected from the surrounding tissue through a suprameatal incision and the urethral wall was incised through the stricture at the 12 o’clock position. A 1.5 cm wide free graft was harvested from the vaginal wall or buccal mucosa in 1 case, and the mucosal surface was placed upon the urethral lumen and sutured with a running 5-zero polyglactin suture to the open urethra. Indwelling 18Fr urethral and 16Fr suprapubic catheters were left in place for 2 and 3 weeks, respectively.
• Results: No additional treatment was required during the 1, 8 and 27 months of followup. All patients had normal micturition following catheter removal.
• Conclusions: Dorsal graft urethroplasty is feasible and effective for the correction of persistent female urethral stricture.
  
  
• Editorial Comment
  The authors describe a method of addressing female urethral stricture through a suprameatal approach. The technique utilized both vaginal wall graft as well buccal mucosa with excellent results.
  These surgeons used the same incision as that used for the suprameatal transvaginal urethrolysis (1). Of note is though significant strictures were addressed, there was no incidence of stress urinary incontinence postoperatively. As discussed with the use of the suprameatal transvaginal urethrolysis, patients should be warned of potential sexual dysfunction utilizing this approach secondary to its proximity to the clitoris1. Though the authors suffered no stress urinary incontinence in their patient population, they do make the excellent point that the area of potential addressment with a suburethral sling is not surgically altered through their urethroplasty approach.

Reference
1. Petrou SP, Brown JA, Blaivas JG: Suprameatal transvaginal urethrolysis. J Urol. 1999; 161: 1268-71.

Dr. Steven P. Petrou
Associate Professor of Urology
Chief of Surgery, St. Luke’s Hospital
Associate Dean, Mayo School of Graduate Medical Education
Jacksonville, Florida, USA