Urethral stricture in female is a rare urological entity. The presenting symptoms are various but voiding difficulty, straining, decreased urine flow rate, increased post-void residue volume, and recurrent UTIs are commonly observed. Storage symptoms are also frequently encountered. (1) Current endoscopic treatment options are associated with very high recurrence rates. (1) In cases of severe and recurrent stricture, a urethroplasty is indicated with success rates ranging between 80%-94% in small series. (2) Different female urethroplasty techniques were described previously but there is no consensus on the optimal urethroplasty technique. Herein, we present a patient who underwent dorsal onlay buccal mucosa graft urethroplasty for female urethral stricture.

A 36-year old female was referred to our department with recurrent UTIs, voiding difficulty, straining and increased postvoid residual volume for the last 27 years. Prior urethral dilatations have failed. Uroflowmetry revealed bladder outlet obstruction. Maximum urinary flow rate (Qmax) was 8 ml/sec, voided volume was 225 ml and the post-void residue was 150 ml.
The patient was placed in high lithotomy position and the perineum was draped and prepped in a sterile fashion. A 12F silicone Foley catheter was used to determine the exact location of the distal portion of the stricture. After hydrodissection, an inverted-U shape vaginal incision was made. An anterior vaginal flap was formed, urethral spongious tissue was dissected and the urethra mucosa was isolated.  Prior to the urethral mucosa incision, stay sutures were placed. A urethral incision was made until normal urethra was identified. The urethra was visualized for any residual stricture with a 9.5F ureteroscope. A 2*2 cm sized buccal graft was prepared, defatted and sutured to the urethral defect with continuous 5.0 polydioxanone sutures. Urethral spongious tissue was sutured over the patch to provide a healthy vascular base for the buccal mucosa graft. The vaginal incision was closed with 2.0 polyglactin sutures.

The patient was discharged home after an overnight inpatient stay and the Foley catheter was removed after 3 weeks. No postoperative complication was observed. Urinary obstruction has relieved significantly after the surgery. Qmax was 26.5 ml/sec, voided volume was 196 ml and the post-void residue was 30 ml at postoperative uroflowmetry at 2 months after surgery.

Dorsal onlay buccal mucosal graft urethroplasty can be a feasible and effective treatment for female urethral strictures.

Spilotros M, Malde S, Solomon E, Grewal M, Mukhtar BM, Pakzad M, Hamid R, Ockrim JL, Greenwell TJ. Female urethral stricture: a contemporary series". World J Urol 2017;35:991-995.
Osman NI, Mangera A, Chapple CR. A systematic review of surgical techniques used in the treatment of female urethral stricture". Eur Urol 2013;64:965-973.