Urethra Male / Female
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.
This video presentation shows the details and surgical steps of the operation.
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.
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).