Female urethral stricture (FUS) is a rare and challenging lower urinary tract dysfunction [1]. Currently, there are no standardized diagnostic criteria or optimal treatment approaches defined. However, surgical treatment remains the gold standard for managing female urethral strictures, with two major techniques commonly utilized [2]. This study aims to compare the surgical outcomes of ventral inlay and dorsal onlay urethroplasty in female patients.

A retrospective analysis was conducted on 31 female patients who underwent buccal mucosa urethroplasty for urethral stricture between 2017 and 2024. The patients were divided into two groups: those treated with ventral inlay buccal mucosa urethroplasty and those treated with dorsal onlay buccal mucosa urethroplasty. Preoperative evaluations included etiology, symptoms, physical examination findings, bladder diaries, ultrasonography, voiding cystourethrography, uroflowmetry, and cystoscopy. Postoperatively, the success rates, complications, and safety of both techniques were compared between the two groups.

The mean age of the patients was 52.4 ± 11.4 years. Urethral stricture was iatrogenic in 21 patients (67.7%) and idiopathic in 10 (32.3%). Preoperative urethral dilation had been performed in 23 patients (74.2%). The mean preoperative urethral calibration and stricture length were 10.5 ± 6.57 Fr and 2.1 ± 1.12 cm, respectively.
Thirteen patients (41.9%) underwent dorsal onlay, while 18 (58.1%) had ventral inlay urethroplasty. Buccal mucosa was used in all cases, and all but one patient in the ventral inlay group also received a Martius flap. The mean Qmax increase was 12.54 ± 4.8 ml/sec in the ventral inlay group and 16.45 ± 12.4 ml/sec in the dorsal onlay group. Preoperatively, 17 patients (10 ventral, 7 dorsal) had clinically significant post-void residual (PVR) volumes (>100 ml), which persisted postoperatively in only 2 dorsal onlay cases. One dorsal onlay patient developed urinary incontinence, and another required reoperation for recurrent stricture. In the ventral inlay group, complications included Martius flap necrosis (n=1), donor site infection (n=2), and hematoma (n=3). No other complications were reported.

Both the dorsal onlay and ventral inlay techniques are effective and safe surgical approaches for treating female urethral stricture. No significant superiority was observed between the two techniques.

The choice of technique should be based on the patient’s specific stricture characteristics and the surgeon’s expertise.

Waterloos M, Verla W, Wirtz M, Waterschoot M, Claeys W, Francois P, Lumen N. Female Urethroplasty: Outcomes of Different Techniques in a Single Center. J Clin Med. 2021 Aug 31;10(17):3950. doi: 10.3390/jcm10173950
Simsek A, Seker KG, Danacioglu YO, Sam E, Ozdemir O, Yenice MG, Atar FA, Tasci AI. Female Urethroplasty With Dorsal Onlay Labia Minora Graft: Technical Details and Initial Results. Female Pelvic Med Reconstr Surg. 2021 Sep 1;27(9):560-563. doi: 10.1097/SPV.0000000000000976