Background: Female urethral stricture disease (FUSD) is an
uncommon yet increasingly recognised cause of bladder outlet obstruction (BOO)
in women that has long been obscured by heterogeneous definitions and overlap
with “female urethral syndrome”. Women typically present with mixed lower
urinary tract symptoms (LUTS) such as thin stream, hesitancy, straining,
prolonged voiding, incomplete emptying, dysuria, and recurrent urinary tract
infection, most often alongside frequency, urgency, nocturia, or incontinence.
Methodology and diagnostic approach: Diagnosis rests on a
synthesis of clinical examination, uroflowmetry and post-void residual urine
estimation, imaging, and endoscopy. Video-urodynamics is reserved for dilemmas
separating BOO from detrusor underactivity.
Surgical management: Endoscopic dilation or direct vision
internal urethrotomy (DVIU) is widely accessible but provides only short-term
relief with high recurrence, especially after repeated procedures. Definitive
management is reconstructive. Technique selection flap-based (vaginal or
labial) versus graft-based (buccal or lingual oral mucosa, vaginal or labial
mucosa) is guided by stricture site, length, tissue quality, and aetiology.
Dorsal onlay buccal mucosal graft (BMG) urethroplasty, exploiting the vascular
support of the clitoral cavernosal tissues and reducing fistula risk, has
become the workhorse for many mid and proximal strictures. Ventral inlay/onlay
approaches are valuable for distal disease or limited dorsal exposure, and
double-face grafting is reserved for obliterative or recurrent cases.
Outcomes: Contemporary series consistently demonstrate ≥80%
success with substantial improvements in flow and residual volumes, high
satisfaction, and preserved continence. Risk factors for failure include longer
strictures, prolonged symptom duration, multiple prior dilations, and lichen
sclerosus.
Conclusion: This review systematises the diagnostic
algorithm, urodynamic evaluation and modern reconstructive techniques for FUSD,
addressing a critical gap in the literature and advocating the need for
prospective, multi-centre trials with standardised definitions and quality of
life endpoints.
Author(s) Details
Punith Jain
Department of Urology & Renal Transplantation, Sri Ramachandra
Institute of Higher Education & Research, Chennai, India.
Suryaram Aravind
Department of Urology & Renal Transplantation, Sri Ramachandra
Institute of Higher Education & Research, Chennai, India.
Vivek Meyyappan
Department of Urology & Renal Transplantation, Sri Ramachandra
Institute of Higher Education & Research, Chennai, India.
Velmurugan
Palaniyandi
Department of Urology & Renal Transplantation, Sri Ramachandra
Institute of Higher Education & Research, Chennai, India.
Hariharasudhan Sekar
Department of Urology & Renal Transplantation, Sri Ramachandra
Institute of Higher Education & Research, Chennai, India.
Sriram Krishnamoorthy
Department of Urology & Renal Transplantation, Sri Ramachandra
Institute of Higher Education & Research, Chennai, India.
Please see the book here :- https://doi.org/10.9734/bpi/mono/978-93-47485-93-0/CH4
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