Update on Female Urethral Reconstruction

Reynaldo G. Gomez; Jessica Pfeifer

Disclosures

Curr Opin Urol. 2021;31(5):486-492. 

In This Article

Abstract and Introduction

Abstract

Purpose of Review: Female urethral stricture (FUS) is not frequent but can be the cause of significant morbidity. A somewhat overlooked condition for years, it has received significant attention in recent times. In this review, we update the current evidence surrounding FUS management.

Recent Findings: It is estimated that FUS is present in about 1% of all women having check-ups for lower urinary tract symptoms. Etiology is considered as idiopathic in half of the cases, iatrogenic in one-third, whereas infection/inflammation and trauma account for the rest. Symptoms presented are usually nonspecific and nondiagnostic. Pelvic examination, uroflowmetry, endoscopy, and urethrography are the most frequently employed diagnostic tools. Urodynamics/video-urodynamics can be used to document obstruction and to differentiate true anatomic strictures from functional disorders. Urethral dilation (UD) is the most frequent management procedure, sometimes followed by self-dilation, but recurrence is high, at over 50%. By contrast, reconstructive surgery is far more efficient, with overall curative rates of around 90%.

Summary: A high index of suspicion is required to identify FUS patients. UD is advised as a first approach but after one or two failed attempts, reconstruction at a referral center should be considered.

Introduction

Female urethral stricture (FUS) was first described in 1824[1] and remained largely ignored for over a century. Despite there has been a growing interest in this entity over the past decade. there still exist numerous aspects of this disease that remain unknown, mainly due its low incidence and variations in the normal voiding function in females, resulting in significant under-diagnosis. We update here the current evidence on FUS management.

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