Female urethral strictures can present significant challenges both from the diagnostic and therapeutic standpoints. The objective of this video is to demonstrate the use of urethral ulrasound in the evaluation and of a buccal mucosa graft in the treatment of female urethral strictures.

Over the past five years, a technique of dorsal onlay buccal mucosa graft urethroplasty has been developped in an academic department of urology striving to improve outcomes compared to existing technique (dilations, vaginal-flap "Blandy" urethroplasty,…). Over the past few months, a gel infused translabial ultrasound technique has been set up in this same department trying to help better evaluating female urethral strictures. These two techniques are presented and described in the present video through the case of a 50 years-old female patient with history of urethral stricture, slow urinary stream, urinary tract infections and urinary urgency and frequency. The patient had undergone multiple dilations in the past with recurrence of the stricture.

For the gel-infused translabial ultrasound, an 8 MHz probe is used to image the urethra while instilling 20cc of lidocaine jelly to distend the urethra. Evaluation of the urethra from meatus to bladder neck is completed and stricture location, length, caliber and presence of peri-urethral fibrosis is assessed. In the case presented herein, the stricture could be clearly identified, located and sized and the peri-urethral fibrosis was patently evidenced.
For the dorsal onlay buccal mucosa urethroplasty, the patient is placed in a dorsal lithotomy position, an 8 Fr urethral catheter is inserted and an incision is made just anterior to the urethra with dissection carried down through the periurethral tissue and the urethra is then opened transversally until the upper part of the stricture. A buccal mucosa graft is then harvested, sized on the stricture length. The graft is defated before to be sutured to the urethra opening using 5/0 pds running sutures. There was no postoperative complications and the patients had significantly improved urinary symptoms as well as urine flow rates postoperatively.

This video demonstrates the feasability of urethral ultrasound in the evaluation, and of dorsal onlay buccal mucosa graft urethroplasty in the treatment of female urethral stricture. Further clinical studies are needed to assess their possible benefits over existing diagnostic and therapeutic tools available in the management of this rare condition.