Female urethral stricture (FUS) is a rare condition that significantly impairs patients’ quality of life and is challenging both from the diagnostic and therapeutic standpoint. There is still no consensus regarding the most appropriate surgical treatment for FUS. Over the past decade, the use of buccal mucosa urethroplasty to treat FUS has been increasingly reported but data are limited and a ventral onlay approach was used in the vast majority of series to date. The aim of this study was to assess the outcomes of dorsal onlay buccal mucosa urethroplasty for FUS.

All female patients who underwent dorsal onlay buccal mucosa urethroplasty for urethral stricture between 2011 and 2017 at a single academic institution were included in a retrospective study. The primary endpoint was clinical success defined as any subjective improvement in storage LUTS self-assessed by the patients four weeks after catheter removal. Pre and postoperative evaluations included an interview with symptoms assessment, a clinical examination, and urinary flow and post-void residual volume (PVR) measurements. A video-urodynamic (VUD) was systematically performed prior to surgery except when the stricture could not be intubated by VUD catheter. Pre and postoperative continuous variables were compared using the paired student t test.

Ten patients were included. The median patient age was 62.5 years. The strictures were located at the proximal, mid and distal urethra in 2, 7 and 1 patients respectively. The median length of the stricture was 0.5 cm. Two patients had a history of previous vaginal-flap urethroplasty with stricture recurrence. Pre-operatively, all patients reported voiding symptoms and six patients complained of storage symptoms. The median operative time was 131 minutes with a median estimated blood loss of 50 ml. Eight cases were performed as outpatient procedures (80%) and two patients were discharged on postoperative day 1. Two patients experienced postoperative complications (20%) all of which were minor (i.e. Clavien grade ≤ 2):  1 urinary tract infection (Clavien grade 2) and 1 sinusitis (Clavien grade 2). The median time of catheterization was 14 days. One patient reported de novo stress urinary incontinence postoperatively (10%) requiring two pads/day. The mean PVR decreased at 1 month postoperatively compared to baseline but did not reach statistical significance (from 140.5 to 48 ml; p=0.12). The mean maximum urinary flow rate increased significantly at 1 month (from 8.2 ml/S to 20.4 ml/s; p=0.007). All reported improvement at 1 month postoperatively (100%). After a median follow-up of 6 months, one recurrence was observed (10%), which occurred 8 months after surgery and was managed with a single balloon dilation with no further recurrence after 6 additional months of follow-up. All patients remained improved at last follow-up visit.

Dorsal onlay buccal mucosa urethroplasty is a feasible option for the surgical treatment of FUS.

Dorsal onlay buccal mucosa urethroplasty for FUS appears to provide satisfactory perioperative and short-term functional outcomes with low risks of de novo urinary incontinence and recurrence.