Female urethral stricture is an often underdiagnosed and complex cause of lower urinary tract symptoms (LUTS). Due to its rarity, standardized management remains a challenge, often leading to repeated and ineffective urethral dilatations. We present the case of a 37-year-old female patient with a long-standing history of obstructive voiding symptoms following a cesarean section in 2013. The patient had previously undergone two unsuccessful urethral dilatations, highlighting the need for a more definitive surgical solution. This video demonstrates the clinical application and efficacy of the Ventral Urethroplasty "AZ" Technique in a patient with refractory female urethral stricture.

The diagnostic evaluation and surgical approach were meticulously planned: 
Clinical Presentation: The patient presented with chronic urinary retention and poor flow. Physical examination revealed a negative stress test, but a 14F catheter could not be advanced through the urethra, confirming a significant narrowing.Pre-operative Uroflowmetry: Confirmed severe obstruction with a Peak Flow Rate Qmax of 6.8 mL/s and a Post-Void Residual (PVR) of 70 cc (Total voided volume 220 mL. Surgical Technique: The "AZ" Technique involves a ventral approach to the urethra. This specific urethroplasty technique focuses on widening the urethral lumen while preserving the surrounding continence mechanisms and minimizing the risk of de novo stress urinary incontinence.

The procedure was performed successfully without intraoperative complications.
Post-operative Recovery: The patient experienced an immediate improvement in voiding dynamics following catheter removal.
Functional Outcome: By adopting the ventral "AZ" approach, we achieved a significant increase in the urethral caliber, allowing for unobstructed voiding.
Patient Satisfaction: At the follow-up, the patient reported complete resolution of obstructive symptoms and no signs of urinary incontinence, a common concern in ventral urethral reconstructive surgeries.

Female urethral stricture should be considered in women with refractory LUTS and a history of difficult catheterization. While dilatation is often the first-line treatment, it frequently fails in recurrent cases. The Ventral Urethroplasty "AZ" Technique represents a safe and effective reconstructive option. It provides durable anatomical results and excellent functional outcomes, proving that a definitive surgical repair is superior to repetitive dilatations in the management of complex female urethral strictures.

Osman, N. I., & Chapple, C. R. (2014). "Contemporary management of female urethral stricture." Current Opinion in Urology.
Spilotros, M., et al. (2017). "Urethroplasty for female urethral strictures: a systematic review." Urology.
Hosseini, S. J., et al. (2010). "Ventral Onlay Urethroplasty in Female Urethral Stricture." International Urogynecology Journal.

Continence 19S (2026) 102740
DOI: 10.1016/j.cont.2026.102740