Abstract
Introduction and hypothesis
To present the surgical details and the outcomes of our modified ventral onlay buccal mucosal graft (BMG) urethroplasty technique in female patients with urethral strictures.
Methods
We included the first seven female patients who had BMG urethroplasty between January 2015 and April 2019 and had at least 6 months of follow-up. Patient age, stricture length, comorbidities, number of previous treatments, pre- and postoperative uroflowmetry data, and post-void residual volumes were recorded.
Results
The mean patient age was 56.7 (44–80) years. The mean stricture length was 3.1 (2–4) cm. The mean postoperative follow-up time was 23 (7–48) months. The preoperative mean maximal flow rate (Qmax) was 5.1 (3.2–9.5) ml/s and post-void residual urine volume (PVR) was 84.4 (37–158) ml. At the 3rd month after surgery, mean Qmax was 31.8 (24.7–36.2) ml/s, and PVR volume was 7.1 (0–16) ml. Three patients had the postoperative 2-year follow-up, and 12th and 24th month mean Qmax values were 28 (23.6–33.2) ml/s and 28.5 (24.1–31.1) ml/s, respectively. The mean operation time was 63.8 (55–113) min. We did not observe any infection, vaginal erosion, urinary incontinence, or oral discomfort due to graft harvesting postoperatively.
Conclusion
Female urethroplasty provides high cure rates and should be performed in case of recurrent FUS. The early and medium-term results of our modified new technique indicated that it might be used as a simple alternative to current techniques. In all of our patients, it significantly increased the flow rate and reduced PVR without any significant complications.
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References
Hoag N, Chee J. Surgical management of female urethral strictures. Transl Androl Urol. 2017;6:76–80.
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. https://doi.org/10.1007/s00345-016-1947-7.
West C, Lawrence A. Female urethroplasty: contemporary thinking. World J Urol. 2019;37(4):619–29. https://doi.org/10.1007/s00345-018-2564-4.
Faiena I, Koprowski C, Tunuguntla H. Female urethral reconstruction. J Urol. 2016;195(3):557–67. https://doi.org/10.1016/j.juro.2015.07.124.
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. https://doi.org/10.1016/j.juro.2012.07.042.
Hoag N, Gani J, Chee J. Vaginal-sparing ventral buccal mucosal graft urethroplasty for female urethral stricture: a novel modification of surgical technique. Investig Clin Urol. 2016;57(4):298–302. https://doi.org/10.4111/icu.2016.57.4.298.
Nayak P, Mandal S, Das M. Ventral-inlay buccal mucosal graft urethroplasty for female urethral stricture. Indian J Urol. 2019;35(4):273–7. https://doi.org/10.4103/iju.IJU_57_19.
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):710–6. https://doi.org/10.1111/bju.13970.
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. https://doi.org/10.1016/j.eururo.2013.07.038.
Kowalik C, Stoffel JT, Zinman L, Vanni AJ, Buckley JC. Intermediate outcomes after female urethral reconstruction: graft vs flap. Urology. 2014;83(5):1181–5. https://doi.org/10.1016/j.urology.2013.12.052.
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 Urol. 2019;8(Suppl 1):S6–S12. https://doi.org/10.21037/tau.2019.03.02.
Osman NI, Chapple CR. Contemporary surgical management of female urethral stricture disease. Curr Opin Urol. 2015;25(4):341–5. https://doi.org/10.1097/MOU.0000000000000186.
O'Connell HE, Hutson JM, Anderson CR, Plenter RJ. Anatomical relationship between urethra and clitoris. J Urol. 1998;159(6):1892–7.
O'Connell HE, Sanjeevan KV, Hutson JM. Anatomy of the clitoris. J Urol. 2005;174(4 Pt 1):1189–95. https://doi.org/10.1097/01.ju.0000173639.38898.cd.
Gozzi C, Roosen A, Bastian PJ, Karl A, Stief C, Tritschler S. Volar onlay urethroplasty for reconstruction of female urethra in recurrent stricture disease. BJU Int. 2011;107(12):1964–6. https://doi.org/10.1111/j.1464-410X.2010.09790.x.
Onol FF, Onol SY, Tahra A, Boylu U. Ventral inlay labia minora graft urethroplasty for the management of female urethral strictures. Urology. 2014;83(2):460–4. https://doi.org/10.1016/j.urology.2013.09.020.
Petrou SP, Rogers AE, Parker AS, Green KM, McRoberts JW. Dorsal vaginal graft urethroplasty for female urethral stricture disease. BJU Int. 2012;110(11 Pt C):E1090–5. https://doi.org/10.1111/j.1464-410X.2012.11233.x.
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. https://doi.org/10.1111/j.1464-410X.2010.09240.x.
Tsivian A, Sidi AA. Dorsal graft urethroplasty for female urethral stricture. J Urol. 2006;176(2):611–3; discussion 613. https://doi.org/10.1016/j.juro.2006.03.055.
Petrikovets A, Sun HH, Kiechle J, Chapman GC, Gonzalez CM, Hijaz A. Ventral-onlay buccal mucosal graft urethroplasty for the treatment of female urethral stricture: a step-by-step video for female pelvic reconstructive surgeons. Int Urogynecol J. 2019;30(12):2191–3. https://doi.org/10.1007/s00192-019-03987-w.
Buckley JC, Heyns C, Gilling P, Carney J. SIU/ICUD consultation on urethral strictures: dilation, internal urethrotomy, and stenting of male anterior urethral strictures. Urology. 2014;83(3 Suppl):S18–22. https://doi.org/10.1016/j.urology.2013.08.075.
Bayne DB, Gaither TW, Awad MA, Murphy GP, Osterberg EC, Breyer BN. Guidelines of guidelines: a review of urethral stricture evaluation, management, and follow-up. Transl Androl Urol. 2017;6(2):288–94. https://doi.org/10.21037/tau.2017.03.55.
Hajebrahimi S, Maroufi H, Mostafaei H, Salehi-Pourmehr H. Reconstruction of the urethra with an anterior vaginal mucosal flap in female urethral stricture. Int Urogynecol J. 2019;30(12):2055–60. https://doi.org/10.1007/s00192-019-03910-3.
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Ozlulerden, Y., Celen, S., Zumrutbas, A.E. et al. Female buccal mucosa graft urethroplasty: a new modified ventral onlay “AZ” technique. Int Urogynecol J 31, 2543–2550 (2020). https://doi.org/10.1007/s00192-020-04354-w
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DOI: https://doi.org/10.1007/s00192-020-04354-w