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Kuo T, Uçar M, Venugopal S, Osman NI, Inman RD, Chapple CR. Female Urethroplasty with a Buccal Mucosa Graft using a Supraurethral Approach. Int Urogynecol J 2024; 35:1093-1095. [PMID: 38324185 DOI: 10.1007/s00192-024-05737-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 01/06/2024] [Indexed: 02/08/2024]
Abstract
INTRODUCTION AND HYPOTHESIS In the setting of recurrent female urethral stricture, urethroplasty offer the best chance of cure. However, which approach (dorsal or ventral) and which tissue (buccal mucosa, vaginal graft, vaginal flap) remain areas of controversy. In this article and accompanying video, we describe female urethroplasty with a supraurethral approach using a buccal mucosa graft. METHODS A stricture of 3 cm in length was observed in the mid urethra. A supraurethral semi-lunar incision was made and dissection was performed up to the stricture. A dorsal urethrotomy was performed and a 3 × 2 cm oral mucosal graft was harvested from the left cheek. The mucosal graft was anastomosed to both urethral edges with running sutures. The graft was fixed to the supraurethral tissue with quilting sutures. A urethral catheter and a suprapubic catheter were left in place for 3 weeks. RESULTS Following removal of the catheters, the patient was able to void satisfactorily with no incontinence. No complications were observed in the urethral area or at the graft harvest site. CONCLUSIONS Buccal mucosa graft urethroplasty with a supraurethral approach is a reliable method in the treatment of female urethral stricture.
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Affiliation(s)
- Tricia Kuo
- Department of Urology, Urohealth Medical Clinic, Singapore, Singapore
| | - Murat Uçar
- Department of Urology, Faculty of Medicine, Alanya Alaaddin Keykubat University, School of Medicine, Antalya, Turkey.
| | - Suresh Venugopal
- Department of Urology, Liverpool University Hospitals, Liverpool, UK
| | - Nadir I Osman
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Richard D Inman
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Christopher R Chapple
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Gul D, Uysal B, Atik YT, Erdik A, Cimen HI, Bostanci MS, Kose O. Ventral onlay buccal mucosa graft urethroplasty for female urethral stricture improves female sexual functions. Int J Impot Res 2023:10.1038/s41443-023-00743-z. [PMID: 37507578 DOI: 10.1038/s41443-023-00743-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 07/30/2023]
Abstract
Female urethroplasty provides excellent results with high success rates in the treatment of female urethral stricture (FUS), but sexual functions after urethroplasty is another concern and have not been adequately investigated. We aimed to evaluate changes in the sexual functions of patients undergoing ventral onlay buccal mucosa graft urethroplasty (VOBMGU). We retrospectively evaluated 18 patients who underwent VOBMGU supported with a Martius labial fat pad flap (MLFPF) in our tertiary referral centre, between 2019 and 2021. After excluding patients who were sexually inactive and those with missing postoperative data, 13 patients were included. Surgical outcomes were assessed with uroflowmetry, the American Urological Association symptom score (AUA-SS), and Urogenital Distress Inventory (UDI)-6. Short Form-36 (SF-36) was used to evaluate the quality of life (QoL). Sexual function was assessed using the Female Sexual Function Index (FSFI) both preoperatively and at 6 months following surgery. The median age was 50 (IQR:44-62) years. There was no surgical failure, and none of the patients developed incontinence or stricture recurrence during a median follow-up of 30 (IQR:12-30) months. The median maximum flow rate increased from 9.2 (IQR:5-11.5) to 19 (IQR:17.35-27.10) ml/s (p = 0.001), the median post-void residual (PVR) volume decreased from 80 (IQR:0-205) to 20 (IQR:10-45) ml (p = 0.021), the median AUA-SS decreased from 19 (IQR:14-22) to 6 (IQR:4-8) (p = 0.001), and the median UDI-6 score decreased from 12 (IQR:6.5-16) to 4 (IQR:2-9) (p = 0.008) postoperatively. Bodily pain and general health perception domains and the physical component summary score were significantly improved in the SF-36 (p = 0.015, 0.022, and 0.009, respectively). The median total FSFI score increased from 17.40 (IQR:1.95-23.65) to 22.60 (IQR:5-24.95) postoperatively (p = 0.004). Improvements were observed in all domains (p < 0.05) except the arousal (p = 0.058) and pain (p = 0.104) domains of the FSFI. We concluded that VOBMGU has good early functional results and improves female sexual function.
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Affiliation(s)
- Deniz Gul
- Sakarya University, Training and Research Hospital, Department of Urology, Sakarya, Turkey.
| | - Burak Uysal
- Sakarya University, Faculty of Medicine, Department of Urology, Sakarya, Turkey
| | - Yavuz Tarik Atik
- Sakarya University, Training and Research Hospital, Department of Urology, Sakarya, Turkey
| | - Anil Erdik
- Sakarya Sadıka Sabancı State Hospital, Department of Urology, Sakarya, Turkey
| | - Haci Ibrahim Cimen
- Sakarya University, Faculty of Medicine, Department of Urology, Sakarya, Turkey
| | - Mehmet Suhha Bostanci
- Sakarya University, Faculty of Medicine, Department of Gynecology and Obstetrics, Sakarya, Turkey
| | - Osman Kose
- Sakarya University, Faculty of Medicine, Department of Urology, Sakarya, Turkey
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Campbell J, Vanni AJ, Kowalik CG. An Update on Female Urethral Stricture Disease. Curr Urol Rep 2022; 23:303-308. [PMID: 36308672 DOI: 10.1007/s11934-022-01113-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW To provide an overview of female urethral stricture disease and updates on surgical outcomes. RECENT FINDINGS In a large retrospective case series, women reported significant improvements in urinary symptoms and quality of life following treatment of their urethral stricture. Both vaginal flap and buccal mucosal graft urethroplasty have higher short- and long-term success rates than urethral dilation. Female urethral stricture disease is rare and surgical reconstruction has the highest likelihood of long-term success. Due to the complexity of reconstruction, referral to a reconstructive trained urologist should be considered.
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Affiliation(s)
- Jack Campbell
- Urology Institute, Lahey Hospital & Medical Center, Burlington, MA, USA.,Department of Urology, Medical Center, University of Kansas, Kansas City, KS, USA
| | - Alex J Vanni
- Urology Institute, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Casey G Kowalik
- Department of Urology, Medical Center, University of Kansas, Kansas City, KS, USA. .,Department of Urology, University of Kansas Health System, 3901 Rainbow Blvd, Kansas City, KS, 66201, USA.
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Kumaraswamy S, Mandal S, Das MK, Nayak P. Long-term Follow-up and Success Rate of Ventral Inlay Buccal Mucosal Graft Urethroplasty for Female Urethral Stricture Disease. Urology 2022; 166:146-151. [PMID: 35588789 DOI: 10.1016/j.urology.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/16/2022] [Accepted: 05/01/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine the long-term success of ventral inlay buccal-mucosal graft urethroplasty (Vi-BMGU) for female urethral strictures (FUS). MATERIALS AND METHODS We performed a retrospective analysis of prospectively maintained data on patients who underwent Vi-BMGU between May 2016 and January 2020 with a minimum follow-up of 2 years. The primary outcome was the long-term success after 2 to 5 years of surgery. Patients were followed with American Urological Association (AUA) symptom score, uroflowmetry, and post-void residual (PVR) urine measurement. Failure (recurrence) was defined by an increase in the AUA symptoms score by 3 on subsequent follow-up visits and maximum flow rate (Qmax) <12 cc/s and inability to calibrate with an 18 Fr catheter. RESULTS Twenty-one patients were included. The Median follow-up was 42 months (range: 24-64 months). The AUA symptom scores, Qmax, and PVR, improved in all except 3 patients. The median AUA score fell from 27 (range 18-34) at diagnosis to 9 (range 6-24), at the last follow-up. Similarly, the median PVR values decreased from 138 ml (34-290) to 24 ml (19-360) and the mean Qmax improved from 7.7 ± 2.2 ml/s to 22.6 ± 5 ml/s. None experienced urinary incontinence. There were 2 failures, 1 at 6 months and the other at 24 months. The overall success rate was 90.5 %. Success rates on life table analysis were 95%, 85%, 85%, 85%, and 85% after 1, 2, 3, 4 and 5 years respectively. CONCLUSION The 95% success at 1 year and 85% sustained success at 2 to 5 years of follow-up establishes the long-term success of Vi-BMGU.
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Affiliation(s)
- Santosh Kumaraswamy
- MS General Surgery, Senior Resident (M.Ch. Urology), Department of Urology, AIIMS, Bhubaneshwar, India
| | - Swarnendu Mandal
- M.Ch. Urology, Assistant Professor, Department of Urology, AIIMS, Bhubaneshwar, India.
| | - Manoj K Das
- M.Ch. Urology, Assistant Professor, Department of Urology, AIIMS, Bhubaneshwar, India
| | - Prasant Nayak
- M.Ch. Urology, Additional Professor and Head of the Department, Department of Urology, AIIMS, Bhubaneshwar, India
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Chakraborty JN, Chawla A, Vyas N. Surgical interventions in female urethral strictures: a comprehensive literature review. Int Urogynecol J 2022; 33:459-485. [PMID: 34185123 DOI: 10.1007/s00192-021-04906-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Female urethral stricture (FUS) is an uncommon entity. Although there is no clinical consensus on the best modality of treatment, several studies have been published describing different techniques of FUS management. We carried out a literature review of the different surgical techniques used in the management of FUS and their results. METHODS We performed a systematic search of the PubMed and EMBASE databases and several cross-references. We grouped the data available from the studies into four general treatment categories. RESULTS We reported 35 studies (488 patients) with outcome measures; 53.48% of cases were presumably idiopathic in origin. A history of prior intervention was described in 91.29% of cases. As a surgical intervention, urethral dilatation (UD) had the lowest success rate of only 41.25%. In contrast, local flaps performed better (92.54% success rate) than local or oral grafts (87.30% and 89.94%, respectively). Only 9.43% of patients experienced mild to moderate post-surgery de novo incontinence; most of them recovered with pelvic floor exercises. CONCLUSION In practice, UD is tried first for FUS, at least once, before urethroplasty. In case of failure or short recurrence following UD, urethroplasty should not be delayed. In experienced hands, urethroplasty has a better outcome.
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Affiliation(s)
| | - Arun Chawla
- Department of Urology, Kasturba Medical College, Manipal, India
| | - Nachiket Vyas
- Department of urology, SMS Medical College, Jaipur, India
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Gülpınar Ö, Zumrutbas AE, Sancı A, Bütün S, Gokce Mİ, Aybek Z. The outcomes of three buccal mucosal graft urethroplasty techniques in women with urethral stricture disease. Neurourol Urodyn 2021; 40:1921-1928. [PMID: 34368998 DOI: 10.1002/nau.24764] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/12/2021] [Accepted: 07/21/2021] [Indexed: 01/20/2023]
Abstract
AIM The purpose of this paper is to present the outcomes of three buccal mucosal graft (BMG) urethroplasty techniques in female patients with urethral strictures. METHODS We included all patients who had BMG urethroplasty for female urethral strictures (FUS) disease between January 2015 and June 2020. Patient age, comorbidities, stricture etiology, stricture length, the number of previous treatments, preoperative and postoperative uroflowmetry data, postvoid residual volumes, and the operation and postoperative course details were documented. RESULTS A total of 34 patients were included in this study. There were 8 patients in vaginal-sparing inlay BMG, 12 for ventral onlay BMG, and 14 for Aybek-Zumrutbas (AZ) technique groups. The mean age of the study population was 56.1 years. The length of urethral strictures varied between one and 4.5 cm. All patients had a previous history of endoscopic treatment or dilatations. The preoperative mean maximal flow rate (Qmax) was 6.9 ml/s. The median postoperative follow-up time was 24.6 months. Twelve months after surgery, the mean Qmax was 25 (range: 14-32) ml/s. There were no significant complications in any patients. The success rates were 83.3% for ventral onlay BMG, 87.5% for vaginal-sparing, and 100% for AZ technique. CONCLUSIONS All three BMG urethroplasty techniques applied in this study had a success rate of over 80% in a median follow-up of approximately 2 years. In females, urethroplasty with BMG provided high rates of cure, and the recently described two techniques (vaginal-sparing inlay BMG, and AZ technique) showed promise in FUS treatment.
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Affiliation(s)
- Ömer Gülpınar
- Department of Urology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ali Ersin Zumrutbas
- Department of Urology, School of Medicine, Pamukkale University, Denizli, Turkey
| | - Adem Sancı
- Department of Urology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Salih Bütün
- Department of Urology, School of Medicine, Pamukkale University, Denizli, Turkey
| | - Mehmet İlker Gokce
- Department of Urology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Zafer Aybek
- Department of Urology, School of Medicine, Pamukkale University, Denizli, Turkey
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Katiyar VK, Sood R, Singla A, Goel HK, Khattar N, Gunavanthe V. Urethral meatus preserving ventral onlay augmentation urethroplasty for female urethral stricture: our technique with initial experience. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00231-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Female urethral stricture (FUS) is an uncommon cause of lower urinary tract symptoms (LUTS) in women. Reconstructive techniques are being increasingly used for strictures resistant to the more conservative form of management. Most forms of reconstruction require cutting open of urethral meatus, thereby resulting in some loss of the meatus function. We hereby describe the technique of urethral meatus sparing ventral onlay mucosal graft augmentation urethroplasty with our initial experience.
Methods
We performed this procedure in 10 cases of FUS with normal meatus and prospectively studied the outcomes over a period of 6 months follow-up.
Results
There was 90 percent success rate with one recurrence. The mean Qmax increased from 7.2 to 19.5 ml/s, mean post-void residual urine (PVRU) decreased from 96.5 to 22.7 ml and the mean IPSS decreased from 26.1 to 5.7. There were no major complications noted and the patients demonstrated significant subjective and objective improvement of symptoms in the follow-up period.
Conclusion
The technique of meatus sparing ventral onlay augmentation graft urethroplasty is a promising approach with good outcomes, is reproducible and has minimal complication rate.
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Chua KJ, Mikhail M, Patel HV, Tabakin AL, Doppalapudi SK, Sterling J, SGR Tunuguntla H. Treatment of Urethral Stricture Disease in Women: Nonsystematic Review of Surgical Techniques and Intraoperative Considerations. Res Rep Urol 2021; 13:381-406. [PMID: 34189132 PMCID: PMC8232966 DOI: 10.2147/rru.s282651] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/02/2021] [Indexed: 11/23/2022] Open
Abstract
Female urethral strictures are rare, but underdiagnosed pathologies that can cause voiding dysfunction. These strictures are best managed with open reconstruction, as endoscopic treatments have high rates of failure. A flap urethroplasty can be performed with vaginal, labial or bladder tissue. Meanwhile, graft urethroplasties can utilize vaginal, labial, buccal or lingual tissue. It is important to consider the etiology and type of stricture, local vascularity, and prior attempts at repair when selecting the type of repair. Multiple different techniques have been described with theoretical advantages to each one. While some studies have reviewed a few of the reconstructive techniques to treat female urethral strictures, no single study has accounted for each individual technique. In this review, we discuss techniques captured by a number of systematic reviews and other articles. We will herein focus on reviewing and describing each unique technique of reconstruction in the setting of female urethral stricture.
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Affiliation(s)
- Kevin J Chua
- Division of Urology, Department of Surgery, Rutgers, The State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA
| | - Mark Mikhail
- Division of Urology, Department of Surgery, Rutgers, The State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA
| | - Hiren V Patel
- Division of Urology, Department of Surgery, Rutgers, The State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA
| | - Alexandra L Tabakin
- Division of Urology, Department of Surgery, Rutgers, The State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA
| | - Sai Krishnaraya Doppalapudi
- Division of Urology, Department of Surgery, Rutgers, The State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA
| | - Joshua Sterling
- Division of Urology, Department of Surgery, Rutgers, The State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA
| | - Hari SGR Tunuguntla
- Division of Urology, Department of Surgery, Rutgers, The State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA
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Coguplugil AE, Ebiloglu T, Sarikaya S, Yilmaz S, Topuz B, Gurdal M. Ventral onlay buccal mucosa graft urethroplasty for female urethral stricture. Int J Urol 2021; 28:538-543. [PMID: 33483992 DOI: 10.1111/iju.14504] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/20/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Female urethral stricture is a rare disease. Urethroplasty with different techniques using grafts or flaps are successful treatment options. The objective of this study was to present our experience with ventral onlay buccal mucosa graft urethroplasty for the treatment of female urethral stricture disease. METHODS Eight female patients treated with ventral onlay buccal mucosa graft urethroplasty were identified retrospectively. Patient evaluation included physical examination, uroflowmetry with postvoid residual urine measurement, videourodynamics and urethrocystoscopy. Stricture was identified by videourethrography and/or urethrocystoscopy. Urodynamic evidence of stricture was considered as a persistent low maximum flow rate of <12 mL/s combined with detrusor pressure at maximum measured flow rate of >20 cmH2 O in the pressure flow study. RESULTS The mean age was 50.5 ± 4.14 years. Stricture etiology was idiopathic (62.5%) or iatrogenic (37.5%). Two patients (25%) had undergone prior urethral dilations before buccal mucosa graft urethroplasty. Mean stricture length was 1.62 ± 0.44 cm. Stricture location was as follows: four distal urethra (50%), two mid-distal (25%) and two mid-urethra (25%). The mean postoperative follow-up period was 16.37 ± 5.75 months, and the during follow-up success rate was 100%. No complication, such as incontinence or vaginal fistula, was noted, except dyspareunia developed in one patient (12.5%). CONCLUSIONS Ventral onlay buccal mucosa graft urethroplasty is a safe and effective treatment option for female urethral stricture. Unnecessary dilation should not be carried out and buccal mucosa graft urethroplasty in expert centers should be recommended to these patients.
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Affiliation(s)
| | - Turgay Ebiloglu
- Department of Urology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Selcuk Sarikaya
- Department of Urology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Sercan Yilmaz
- Department of Urology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Bahadir Topuz
- Department of Urology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Mesut Gurdal
- Department of Urology, Gulhane Training and Research Hospital, Ankara, Turkey
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