Female urethral stricture (FUS) is rare and generally managed endoscopically. Whilst urethroplasty is increasingly reported it is not known who may benefit from this intervention. We have assessed the history, imaging and urodynamic
characteristics of all women seeking urethroplasty for recurrent symptomatic FUS.

Materials & Methods A retrospective review of a prospectively acquired database of 55
consecutive women (median age 51 years, range 25-71) with recurrent FUS having
urethroplasty since June 2012 with a minimum follow up of 6 months (median 25 months,
range 6-96). Data was analysed for stricture aetiology, presenting symptoms, previous
stricture treatment, MRI and videourodynamic findings and type of urethroplasty. Statistical
analysis was performed with the Wilcoxon signed rank test, Students T Test and Mann-
Whitney U Test. Statistical significance was determined as P<0.05.

Results Stricture aetiology was unknown in 42(76%), urethral diverticulum excision in 5(9%),
female genital mutilation in 2(3%), lichen planus in 2(3%), vaginal radiotherapy in 2(3%),
pelvic fracture urethral injury in 1(2%) and TVT removal in 1(2%). Median duration of
symptoms was 60 months (range 24-320). The commonest symptoms were poor flow
54(98%), frequency 44(80%), nocturia 42(76%), urgency 40(73%), urethral pain 40(73%) and
recurrent UTI 40(73%). The women had had a mean of 6.7 previous urethral dilatations
(range 0-38). 32(58%) had been performing ISC for a mean of 30.4 months (range 0-120)
and all found it painful and 2(4%) had indwelling suprapubic catheters. MRI pelvis revealed
a concentrically thickened urethra in 32/50(64%), urethral diverticulum in 4(8%), an absent
urethra in 1(2%), tethered and anterolaterally deviated urethra in1(2%) and no abnormalities
in 12(24%). Videourodynamics revealed bladder outjow obstruction in 52/52(100%),
detrusor overactivity in 20(38%) and stress urinary incontinence in 7(13%). Preoperatively
mean Qmax was 6.6mls/s (range 0-23), mean Pdet Q max was 76.6 cmH2O (range 0-165)
and mean Solomon-Greenwell BOOIf was 60.72 (range -24.2-156) (where BOOIf>5 =>50%
chance of BOO). Mean stricture length was 1.8cm (range 0.5-4.0cm) and the commonest
sites were distal in 20(36%) and mid-distal in 17 (31%). 46(84%) had ventral onlay buccal
mucosal graft urethroplasty, 7(13%) had ventral vaginal jap urethroplasty, 1(2%) had ventral
onlay labial minora jap urethroplasty and 1(2%) had a meatoplasty – with stricture free
status in 51(92.7%) at a mean follow-up of 30.4 months (range 6-96).

The majority of females with  urethral stricture  have irritative LUTS and urethral pain.

Poor flow secondary to urodynamic bladder outflow obstruction is present in almost all women with FUS. 

Definitive treatment with urethroplasty is significantly delayed whilst endoscopic management is possibly overused.

Conclusions 

Female Urethral Stricture should be suspected in all women with poor flow and irritative LUTS 

Urethroplasty should be considered earlier  and delay caused by overuse of endoscopic management  should be avoided.