The diagnosis of female lower urinary tract obstruction (FLUTO) is elusive. It occurs in 2.7% to 8% of women presenting with lower urinary tract symptoms (LUTS), and may be caused by both anatomical and functional conditions. Anatomical causes of FLUTO includes intrinsic causes such as urethral stricture, periurethral diverticulum, vesicovaginal fistula, and urethral tumors; extrinsic causes such as incontinence surgery, periurethral fibrosis, periurethral cyst, fibroids and anterior vaginal wall lesions; and positional causes such as angulation due to pelvic organ prolapse.
Female urethral stricture (FUS), like other anatomical causes, restricts the maximum radius that the urethra can reach at the peak of its relaxation, increasing resistance to voiding flow. This may result in a reduced flow, augmented detrusor pressure during emptying, or both. FUS occurs in 4-13% of cases, which is equivalent to 0.1-1% of all patients with LUTS. Reports have shown a median age of onset of 50 years, being caused by either idiopathic factors (49-51%), iatrogenic factors (33-36%), inflammatory or infectious factors (8%), and trauma or straddle injury (7-15%).
There is currently no consensus on the definition of FUS and the diagnosis should be multimodal. Available diagnostic tools include urethral calibration, retrograde and/or antegrade (through cystostomy tract) evaluation with flexible cystoscope or semi-rigid ureteroscope, voiding cystography, post void residual volume, uroflowmetry and, in some cases, urodynamics.
The clinical symptoms of FUS include a weak stream, a sensation of poor voiding, recurrent urinary tract infections, urethral pain, urinary incontinence, urinary retention or elevated postvoid residual, among others. In the terminal stages of FUS, secondary claudication of bladder contractility and accommodation may occur, which is usually irreversible.
The most common treatment for FUS is urethral dilatation (UD), which has shown success rates of only 43-49% in the long term (75.1% as first treatment and only 26.6% in those with one or more previous UDs).
Female urethroplasty, on the other hand, has accumulated consistently favorable experience over the last decade. For involvement of the most distal centimeter only, an advancement meatoplasty can be performed, resecting the narrowed segment. For all other cases, enlargement urethroplasty has shown long-term success rates between 92% and 88-95%, either with flaps or grafts, respectively. Our group has opted for the dorsal onlay with buccal mucosa graft urethroplasty (DO-BMGU) technique.
The aim of this abstract is to characterize the demographic, clinical and perioperative variables and to analyze the medium-term outcomes of our series of female urethroplasty procedures performed with DO-BMGU.