Vestibular flap urethroplasty for strictures of the female urethra. Impact on symptoms and flow patterns

Introduction: To assess the impact on subjective symptoms and flow patterns of a new surgical technique designed to correct strictures of the female distal urethra and urethral meatus. Materials and Methods: Seventeen patients (mean age 41.2 years) with symptomatic strictures of either the distal urethra or the urethral meatus entered the study. Patients reporting an AUA score > 20, a diagnosis of bladder outlet obstruction according to the Abrams-Griffiths nomogram and the Schaefer linPURR diagram, urethral calibration < 20 F and radiologic evidence of the stricture, were considered eligible for surgery. A pedicled flap isolated from the vaginal vestibule was anastomosed with two longitudinal running sutures along the two edges of an opened urethra. Results: In all cases, diffuse fibrosis of the urethral wall was demonstrated at histological examination. Mean (± SE) preoperative and 12-month follow-up results were as follows: AUA score 25.2 ± 2.1 vs. 8.4 ± 1.2 (p < 0.0001); peak flow rate (ml/s) 13.2 ± 1.2 vs. 36 ± 1.5 (p < 0.0001); detrusor pressure at Qmax (cm H2O) 45 ± 5 vs. 17 ± 3; residual urine volume (ml) 120 ± 5 vs. 20 ± 5 (p <0.0001). Fifteen patients (88%) showed an unobstructed Abrams-Griffiths nomogram and a Schaefer linPURR diagram postoperatively. All but 2 cases (88%) could be calibrated at 28 F postoperatively and showed a normal urethral lumen at voiding cystourethrography. Complications were never noted. Conclusions: Female patients with symptomatic strictures of the distal urethra or urethral meatus may be treated efficaciously and safely with vestibular flap urethroplasty. Although this technique must be performed under optical magnification it is easy to perform and is not associated with complications