Hypothesis / aims of study
The incidence of FUS is reported to be low (0.1-1%) and 4-10% among females with bladder outlet obstruction. However, the true incidence of FUS is still unknown. The lack of uniform criteria for diagnosing FUS poses a major challenge for urologists worldwide. The lack of uniform criteria for diagnosing FUS poses a major challenge for urologists worldwide. The first description of vaginal flap urethroplasty was by Hariss in 1935. It took a long time for urologists to acknowledge female urethral reconstructive procedures due to their difficulty and imminent threat to functional and sexual complications. Urethral dilatation has remained the first and most frequent treatment method for female urethral stricture. Recently, dorsal onlay buccal mucosal graft urethroplasty has become a popular and preferred choice of urethral stricture repair. Another surgical repair, Ventral inlay buccal mucosal graft urethroplasty, has also shown promising outcomes in limited series. The main advantage of the Ventral inlay buccal mucosal graft urethroplasty technique over dorsal onlay buccal mucosal graft urethroplasty is preserving the neurovascular bundle . However, there has yet to be a study published to date comparing these techniques. In our study, we aim to compare Ventral inlay buccal mucosal graft urethroplasty with dorsal onlay buccal mucosal graft urethroplasty for the treatment of female urethral stricture.
Study design, materials and methods
Between Sept 2019 and May 2023, 40 women with USD were randomized to undergo either Ventral inlay buccal mucosal graft urethroplasty or dorsal onlay buccal mucosal graft urethroplasty. All were evaluated preoperatively with American Urological Association (AUA) symptom score, Uroflowmetry, and Post-void residual (PVRU) urine. Intraoperatively, USD was confirmed with a 6 Fr 30o cystoscope, length and location of stricture, blood loss and duration of surgery were noted. Postoperative evaluation included, visual analogue score (VAS), need for analgesia, follow-up after surgery with AUA symptom score, Uroflowmetry, and PVRU
Interpretation of results
This was a randomized trail comparing result of Ventral inlay buccal mucosal urethroplasty and dorsal onlay mucosal urethroplasty showed that the ventral inlay technique was associated with shorter surgery duration and less blood loss compared to the dorsal onlay technique. The ventral inlay group also reported lower pain scores at 6 hours post-surgery and required less analgesia. Both groups had successful voiding after catheter removal, and there were no significant differences in improvement in AUA score, maximum flow rate (Qmax), and reduction in post-void residual urine (PVR) at 3, 6, and 12 months.
The success rates of the two techniques were high, with 96% success in the ventral inlay group and 93% success in the dorsal onlay group at 1-year follow-up. However, there was no statistically significant difference in success rates between the two groups.