Study design, materials and methods
The prospectively collected data of the patients underwent ventral BMG urethroplasty was reviewed retrospectively. A maximum urinary flow rate (Qmax) of <12 mL/s, inability to calibrate the urethra with a 12-French (Fr) catheter, or requirement for any secondary intervention, including urethral dilation was considered as failure. Cases that did not fulfill these criteria were classified as successful.
Results
The study included 25 female patients with a mean age of 50 ± 8.1 years. Stricture etiology was equally distributed between iatrogenic and idiopathic causes, and all patients had a history of prior urethral dilation. Ventral BMG urethroplasty was performed using a ventral onlay approach in 11 patients (44%) and a ventral inlay approach in 14 patients (56%). Median operation time was 60 minutes. The median length of hospital stay was 3 days. Postoperative complications were infrequent and generally minor. No cases of de-novo stress urinary incontinence or urethrovaginal fistula were observed. One patient(4%) developed a postoperative urinary tract infection and one patient(4%) experienced a wound infection. At a median follow-up of 19 months, the overall success rate was 80%(Table-1). After stratification of patients into VO and VI groups, the baseline demographic and preoperative clinical characteristics —including age, BMI, smoking habits, etiology of the stricture, history of previous treatments, stricture location and length, as well as preoperative Qmax and PVR — were comparable between the two groups (Table-2). The median stricture length was 2 cm in both groups (Table-2). Median operation time was significantly shorter in the VI group (95 (90-130) minutes vs. 49 (42-55) minutes; p<0.001). The total hospital stay was 2 and 3 days for the VO and VI groups, respectively. Catheter removal time was 16 days for both groups. The overall incidence of complications was minimal, with no discernible difference between the groups. Success was achieved in 72.7% and 85.7% of the patients in VO and VI groups, respectively, with a median follow-up period of 18 and 19 months (Table-3). In both groups, the Qmax value showed a statistically significant improvement postoperatively. In the VO group, Qmax increased from 6.6 ml/sec to 24.7 ml/sec (p=0.007). In the VI group, mean Qmax increased from 7.5 ml/sec to 20.4 ml/sec (p<0.001). In the VO group, median PVR decreased from 45 (27-135) mL to 35 (30-55) mL (p=0.122). In the VI group, PVR decreased from 60 (50-100) mL to 40 (24-52) mL (p=0.074).
Interpretation of results
This study has confirmed that ventral BMG urethroplasty is an effective and safe technique for addressing urethral stricture in women. Additionally, it demonstrated that the vaginal-sparing ventral inlay technique yielded a statistically significant reduction in operation time compared to the ventral onlay technique. This indicates that it may emerge as a significant alternative, particularly for patients with substantial comorbidities and elderly individuals, where minimizing anesthetic duration may be essential. Moreover, owing to to the current revival in the popularity of vaginal/vestibular grafts, it can be anticipated that similar procedures can be executed in relatively short durations utilizing vaginal/vestibular grafts under spinal anesthetic exclusively, without oral morbidity.