Female urethroplasty with buccal mucosa graft quilted to the vaginal flap

Aybek Z1, Çelen S1, Özlülerden Y1, Zümrütbas A E1

Research Type

Clinical

Abstract Category

Urethra Male / Female

Abstract 673
Non Discussion Videos
Scientific Non Discussion Video Session 35
Surgery Voiding Dysfunction Female Grafts: Biological
1. Pamukkale University School of Medicine, Department of Urology, Denizli, Turkey
Links

Abstract

Introduction
A 49 year old female patient presented with a history of recurrent urethral stricture disease. She had symptoms of intermittency, slow stream and dysuria for thirty years. She had a history of urethral dilatations for three times in the past. Acoording to meical history she underwent left oopharectomy and  cesarean section  and she was not on any medications. The physical examination demonstrated normal vital signs, normal external female genitalia. Urinalysis and creatinine levels were within normal limits. Maximum flow rate was found 9,5 ml/min and 37 ml post-void residual urine was determined. We found that full lenght uretral stricture in urethroscopy and the patient underwent buccal mucosa graft urethroplasty.
Design
This video presentation shows the details and surgical steps of the operation.
Results
The patient was successfully treated with this surgery. Peroperative and postoperative complications was not observed. The patient was discharged three days after surgery. After three weeks urethral catheter was removed. Maximum flow rate was found 35,1 ml/min and post void residual urine was not determined (Figure 1). Urinary incontinence was not observed.
Conclusion
Female urethral stricture is a rare condition and causes may include trauma,  iatrogenic injury, infection, malignancy, and radiation (1).  Urethral dilation and endoscopic management have an important role in the management of urethral stricture but their efficacy are low espesially comlex and recurrent stricture. Vaginal and labial flaps or vaginal and oral mucosal grafts have been used for reconstructive management of female urethral stricture. In our technique we use ventral (6 o’clock ) buccal graft urethroplasty and quilted graft to anterior vajinal flap. So we avoid of dorsal urethral dissection and this provides lower risk of sexual dysfunction and urinary incontinence. And quilting graft to vaginal flap tissue provide more blood supply via  and reduced area between flap and graft.


Buccal mucosa graft urethroplasty for female urethral stricture has proven an excellent treatment option and success rate found about 94% (2).
Figure 1
References
  1. Faiena I, Koprowski C, Tunuguntla H. Female urethral reconstruction. J Urol 2016;195:557-67. 10.1016/j.juro.2015.07.124
  2. Osman NI, Chapple CR. Contemporary surgical management of female urethral stricture disease. Curr Opin Urol 2015;25:341-5
Disclosures
<span class="text-strong">Funding</span> None <span class="text-strong">Clinical Trial</span> No <span class="text-strong">Subjects</span> Human <span class="text-strong">Ethics not Req'd</span> This is a case presentation and taken permission from patient <span class="text-strong">Helsinki not Req'd</span> This is a case presentation and taken permission from patient <span class="text-strong">Informed Consent</span> Yes