Ventral onlay buccal mucosa graft urethroplasty for female urethral stricture

Comparison of Ventral Inlay and Dorsal Onlay Urethroplasty for Female Urethral Stricture

OBJECTIVE

To compare the outcomes of Ventral inlay buccal mucosal graft urethroplasty (VIBMGU) with dorsal onlay buccal mucosal graft urethroplasty (DOBMGU) for the treatment of Female urethral stricture (FUS).

MATERIAL AND METHODS

This study included women who underwent either VIBMGU or DOBMGU between January 2016 and June 2023. The preoperative American Urological Association (AUA) symptom scores, maximal urinary flow rate (Qmax), post-void residual volume (PVR) on ultrasonography, and length and location of the stricture were obtained from a prospectively maintained electronic database. The data obtained from the patient's last visit were compared with the preoperative values for this study. The primary outcome was the success rate. The secondary outcomes were changes in AUA score, PVR, and Qmax. The patient's last follow-up visit was considered for the duration of the follow-up.

RESULTS

Seventy-three patients were treated for BMGU for FUS. Forty-six patients underwent VIBMGU, and 27 patients underwent DOBMGU. The median duration of follow-up was 27.5 (11.00-55.00) versus 14 (7.00-17.00) months, respectively. The success rates of VIBMGU and DOBMGU were 89.13% and 88.89%, respectively. There was a reduction in AUA scores and PVR and an improvement in Qmax postoperatively in both groups. The difference in the reduction in AUA scores between the VIBMGU and DOBMGU groups was statistically significant. The difference was not statistically significant in terms of reduction in PVR and improvement in Qmax between the 2 groups.

CONCLUSION

The ventral inlay technique can provide equal results to the dorsal technique with the added advantage of vaginal sparing. This is the single largest series in the literature on FUS with the largest follow-up period of 90 months.

Ventral Onlay Buccal Mucosa Graft Urethroplasty for Female Urethral Stricture: Medium-term Results in a Single Surgeon Experience

OBJECTIVE

To describe our own approach using buccal mucosal grafting and to assess the outcome of this approach.

MATERIALS AND METHODS

A total of 42 patients underwent ventral onlay BMG by a single surgeon between 2017 and 2022. A longitudinal incision along the length of the urethra was made through the anterior vaginal wall and the periurethral fascia was incised to create 2 flaps. This ventral urethrotomy ran from the meatus into the proximal healthy urethra above the level of the stricture. A buccal mucosal graft was harvested and sutured to the margins of the urethral mucosa itself and the flaps of periurethral fascia. The vaginal wall was then closed.

RESULTS

The mean age of the patients was 53.6 ± 12.8 years. There were no perioperative or postoperative complications. At a mean follow-up of 38.1 months, 41 patients (98%) were stricture-free. Peak flow rate improved from a mean of 7.7 ± 3.2 mL/s preoperatively to 25.9 ± 5.9 mL/s postoperatively. No patient developed incontinence. One patient developed a recurrent urethral stricture which was treated by redo urethroplasty.

CONCLUSION

The surgical technique applied has proved efficiency. The ventral BMG preserves the urethral sphincter and so avoids postoperative incontinence. The use of periurethral fascia represents a good vascular and mechanical support for the graft.

Female ventral-onlay buccal mucosal graft urethroplasty supported with martius labial fat pad flap: early results

PURPOSE

There is a growing interest in reconstructive urology and female urethroplasty. We aimed to report our experience in ventral-onlay buccal mucosa graft (BMG) urethroplasty supported with Martius flap (MF) in treating female urethral stricture disease.

METHODS

We retrospectively evaluated data of 18 female patients (ages 35-78) who were diagnosed with urethral stricture disease and underwent ventral-onlay BMG urethroplasty supported with MF by single surgeon in a tertiary referral centre between February 2019 and October 2022. Detailed history, international prostate symptom score (IPSS), pelvic examination, urine flow rate (rate and pattern), post void residual (PVR), storage and voiding phase urodynamic study, and voiding cystourethrography were recorded. At the last visit; the number of urethral dilatations before urethroplasty, time from urethral dilation to urethroplasty, hospital stay, urethral catheterization time, postoperative IPSS, PVR and uroflowmetry values were recorded.

RESULTS

The presenting symptoms were obstructive voiding symptoms in 16 patients. While the mean number of urethral dilatation was 2.11 ± 1.93 (1-7), the mean time from dilatation to urethroplasty was 5.83 ± 5.00 (1-19 months) months. Maximum flow rate increased from 8.36 ± 3.26 ml/sec in preoperative uroflowmetry to 21.45 ± 5.27 ml/sec at the last follow-up (p < 0.001). Post-void residual urine (PVR) decreased from preoperative mean 116.66 ± 105.88 cc to 26.94 ± 22.69 cc postoperatively (p < 0.004). None of the patients developed stricture recurrence, incontinence or vaginal fistula until the last follow-up. The mean follow-up period was 17.28 ± 11.65 (1-35) months.

CONCLUSIONS

A ventral-onlay BMG urethroplasty supported with MF represents an effective and reproducible treatment option for FUS in the present study.

An Update on Female Urethral Stricture Disease

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.

Prospects and Challenges of Electrospun Cell and Drug Delivery Vehicles to Correct Urethral Stricture

Current therapeutic modalities to treat urethral strictures are associated with several challenges and shortcomings. Therefore, significant strides have been made to develop strategies with minimal side effects and the highest therapeutic potential. In this framework, electrospun scaffolds incorporated with various cells or bioactive agents have provided promising vistas to repair urethral defects. Due to the biomimetic nature of these constructs, they can efficiently mimic the native cells’ niches and provide essential microenvironmental cues for the safe transplantation of multiple cell types. Furthermore, these scaffolds are versatile platforms for delivering various drug molecules, growth factors, and nucleic acids. This review discusses the recent progress, applications, and challenges of electrospun scaffolds to deliver cells or bioactive agents during the urethral defect repair process. First, the current status of electrospinning in urethral tissue engineering is presented. Then, the principles of electrospinning in drug and cell delivery applications are reviewed. Finally, the recent preclinical studies are summarized and the current challenges are discussed.

Long-term Follow-up and Success Rate of Ventral Inlay Buccal Mucosal Graft Urethroplasty for Female Urethral Stricture Disease

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.

Female urethral stricture: which one is stronger? Labial vs buccal graft

INTRODUCTION AND HYPOTHESIS

We aimed to compare labial and buccal mucosa graft methods in female urethroplasty.

METHODS

Female urethroplasty surgeries performed between March 2016 and October 2020 were retrospectively reviewed. Labial and buccal mucosa graft surgeries were listed.

RESULTS

Between March 2016 and October 2020, a total of 28 patients had graft urethroplasty surgery in our center. Fourteen had labial, 14 had buccal onlay graft urethroplasty. The pre-treatment Qmax values were 13 ml/s in the labia major onlay graft (LMOG) group and 12.5 ml/s in the buccal mucosa onlay graft (BMOG) group. The Qmax values after the treatment were remeasured at the 1st, 3rd, and 12th months. They were 20 ml/s, 24 ml/s, and 24 ml/s in the LMOG group and 23 ml/s, 25 ml/s, and 28 ml/s in the BMOG group. The operation times were 65 min (55-90) in the LMOG group; in the BMOG group, it was 70.35 min (65-90).

CONCLUSIONS

In female urethral strictures, especially in long segments and recurrent strictures, graft urethroplasty is a successful and safe method. Dorsal buccal onlay mucosal graft and labia major grafts show similar results in the early period to complications and success. In the long term, buccal onlay mucosal graft gives better results.

Surgical interventions in female urethral strictures: a comprehensive literature review

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.