The exact duration for which a per urethral catheter must be kept in situ following urethroplasties is not known in female urethroplasties. Most often, it is based on the surgeon’s preference and experience from male urethroplasty. Usually, PUC is removed after 3-4 weeks of surgery. In males, few retrospective studies have shown that catheter removal as early as seven days following augmentation urethroplasties and three days following anastomotic urethroplasties is possible with no significant difference in success rates. There is a scarcity of existing literature about female urethroplasties, the disease entity of female urethral stricture being rare. The general practice is to keep the PUC for at least three to four weeks after surgery. Buccal mucosal graft (BMG), being a type of free graft, takes about 96 hours to take up by the process of inosculation completely. Moreover, prolonged catheterization adds to the patient’s bother by increasing the duration of catheter-associated pain, bladder spasms, risk of urinary tract infection, resulting in poor quality of life. Aim of this study was to assess the result of early removal of catheter following Ventral Inlay buccal mucosal urethroplasty in female urethral stricture disease.

It was a prospective observational study including all female undergoing Ventral Inlay buccal mucosal urethroplasty between April 2023 and July 2023. Following the surgery, a 16Fr silicone indwelling catheter was kept in situ for 7 days before removal. All the outcome parameters were assessed preoperatively and at 1- and 3-months follow-up visits. Recurrence in symptoms, increase in AUA symptom score, maximum flow rate (Qmax) >/=12 ml/s, failure to calibrate the urethra with an 18 Fr catheter, and demonstration of narrowing of the urethra on urethroscopy with a standard 19 Fr sheath were used to define recurrence of the stricture. The Friedman test was used for statistical significance using SPSS software. The primary objective was the success rate at 3 months. The changes in American Urological Association (AUA) symptom score, peak flow rate (Qmax), and post-void residue (PVR) post-operatively at 1 and 3 months were secondary objectives.

15 women with a mean age of 44.086.75 years underwent Ventral Inlay buccal mucosal urethroplasty in the study period. None of the patients had a recurrence at 6 months follow-up. The median pre- operative AUA score was 25.5 (IQR 21.25-32.75), and the post-operative AUA scores at 3 and 6 months were 10 (8-13.5) and 9.5 (6.25-15.25) respectively (p<0.05). The median pre- operative Qmax (ml/sec) was 9 (IQR 6.25-10.75). They increased to 21 (18-27.75) and 22 (18.25-26.75) at 3 and 6 months, respectively (p<0.05). The median pre-operative PVR (ml) was 238.25 (IQR 98.25-285.5), and PVR at 3 and 6 months were 34.5 (21.25-53) and 25 (16.25-65) respectively (p<0.05). 5 patients had completed 12-month follow-up, and none of them had recurrence.

This prospective observational study showed that none of the patients had a recurrence at the 6-month follow-up. There was a significant improvement in AUA symptom scores, Qmax, and PVR at 3 and 6 months compared to pre-operative values (p<0.05). These findings suggest that early removal of the catheter following Ventral Inlay buccal mucosal urethroplasty in female urethral stricture disease is safe and effective, with good outcomes at 6 months and no recurrence in the patients who completed 12-month follow-up. This approach may lead to improved patient comfort and quality of life by reducing the duration of catheter-associated issues.

Early indwelling catheter removal following Ventral Inlay buccal mucosal urethroplasty for Female urethral stricture disease is equally effective. Further studies with larger sample sizes and longer follow-up periods are warranted to confirm these results and establish optimal catheterization durations for female urethroplasties

Al-Qudah HS, Cavalcanti AG, Santucci RA. Early catheter removal after anterior anastomotic (3 days) and ventral buccal mucosal onlay (7 days) urethroplasty. Int Braz J Urol. 2005 Oct;31(5):459–64.
Fichtner J, Filipas D, Fisch M, Hohenfellner R, Thüroff JW. Long-term outcome of ventral buccal mucosa onlay graft urethroplasty for urethral stricture repair. Urology. 2004 Oct;64(4):648–50.