Bladder outlet obstruction (BOO) is an uncommon cause of female lower urinary tract symptoms (LUTS) with an estimated prevalence of 2.7-8%. Fe male urethral stricture (FUS) is an even more rare condition that accounts for 4-18% of the patients with so called BOO. According to the low prevalence of urethral stricture in women, there is no widely accepted consensus on the definition of FUS and its diagnostic criteria in the literature. In the present study, we aimed to investigate the role of trans-labial ultrasound study in detection of urethral stenosis and distinguish it from other causes of female LUTS; furthermore, evaluating the practical value of this method in comparison to former cysto-urethroscopy as the currently available definitive diagnostic modality.

In this cross-sectional study, 60 consecutive females with obstructive LUTS lasting for at least 6 months and failed conservative and medical treatment from 2019 to 2022 were included in this study. The presence of grade 3 cystocele or rectocele, untreated urinary tract infection, para-urethral cysts, urethral prolapse, urethral diverticula, spinal cord injury or any known neurologic disease and lack of patients’ consent to participate were considered as exclusion criteria. For additional assessment, all these patients underwent gel-Infused trans-labial ultrasound (GITLUS) and cystourethroscopy. Trans-labial real-time ultrasonography was performed following the insertion of 20 ml steady stream viscous jelly into the urethral meatus to assess the length of the urethra and exact location and length of the probable narrowing, as well as the presence of peri-urethral fibrosis (PUF).

In GITLUS evaluation, urethral stricture was found in 27 patients. Mean urethral length and stricture length were 35.63 ±4.78 and 17.04 ±10.59, respectively. All these stenosis were confirmed via cysto-urethroscopy. PUF was found in 20 of 27 patients. In cysto-urethroscopy, urethral stricture was confirmed in 40 patients: 13 in urethral meatus and 27 in other parts or pan-urethra.

GITLUS could not reveal urethral stricture in 13 patients with meatal stenosis, confirmed with cystoscopy. GITLUS detected FUS less accurately when it involves pure distal urethra compared to other parts of urethra or pan-urethral stenosis (p value = 0.002).

GITLUS is a safe, non-invasive, and valuable technique for detecting FUS. The strengths of this modality include the lack of need for anesthesia, ionizing radiation, and urethral catheterization. It can accurately identify the location and length of the stricture. Additionally, it can evaluate peri-urethral pathologies such as PUF, which can be important for surgical planning and outcome. However, in meatal or pure short length distal urethral strictures, this method should be use with caution.

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Agochukwu-Mmonu N, Srirangapatanam S,  Cohen A, Breyer B. Female Urethral  Strictures: Review of Diagnosis, Etiology,  and Management. Curr Urol Rep. 2019;  20: 74.