Volar onlay urethroplasty for reconstruction of female urethra in recurrent stricture disease

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Study Type – Therapy (case series)Level of Evidence 4What’s known on the subject? and What does the study add?In spite of several suggestions that have been published recently, there is no standard procedure for therapy of recurrent female urethral stricture disease. Most of the published procedures are characterized by the time-consuming use of an oral mucosal graft.In the current study we present an effective and simple new technique for reconstruction of strictured female urethra, using a free labium minus graft.OBJECTIVE•To report our experience with a new and simple method of urethral repair with a volar onlay of free labium minus graft. Strictures of the female urethra are rare, and it is well accepted that the therapeutic options of dilation and urethrotomy are not lasting solutions as a result of their high recurrence rates. However, there is no consensus regarding the best way to reconstruct the female urethra in the case of stricture disease.PATIENTS AND METHODS•Four consecutive female patients with a long lasting history of recurrent urethral strictures underwent open urethroplasty with a volar situated free split thickness epidermal graft from the labium minus.•The surgical technique is described and a short-term follow-up is presented.RESULTS•Operating time was 40–140 min (mean 105 min), and the graft measured between 2 × 1.5 cm and 3 × 2.5 cm. Follow-up time was 11–19 months. Maximum urinary flow rate could be improved from a baseline of 9.4–11.2 mL/s (preoperatively, after intermittent use of dilation) to 19–23 mL/s.•Postvoid residual urine volume was 0–50 mL preoperatively and no postvoid residual urine volume postoperatively.•Urinary catheters were removed after 21 days. Urinary stress incontinence did not occur postoperatively. No complications related to the graft donor site were found.CONCLUSIONS•The reported data concerning a new therapeutic approach for the treatment of recurrent female urethral stricture show that a volar onlay urethroplasty represents a feasible, safe and simple surgical method.•Larger series with long-term follow-up are needed for further evaluation.

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