Successful management with longterm clean intermittent catheterization after urethral dilatation to report our. Successful treatment of male urethral stricture requires selection. Female urethral strictures are rare but can cause severe symptoms impacting the patients quality of life. Although urethral dilation continues to be performed at a high frequency in women despite lack of proven efficacy, this procedure is used for a variety of voiding complaints other than stricture. Successful management with longterm clean intermittent catheterization after urethral dilatation. Lateralbased anterior vaginal wall flap in the treatment of. Oral mucosal buccal graft urethroplasty also has high success rates, with larger series demonstrating feasibility and durability. Urethral stricture disease is defined as a narrowing of the urethra between its origination at the bladder and its outlet at the penis tip. Female urethral stricture diseases austin publishing group. In those women with known boo, fus account for between 418% of these cases 6,7. This narrowing often causes difficulty with passing urine, including straining and pain in the urethra. Urethral stricture in women is not so common as compared to men in whom urethral stricture occurs more often. Docplexus is an online community consisting of more than 300k.
Urethral reconstruction was found to be successful in 16 cases 80% at a. Urethral disorders genitourinarykidney forums patient. The dorsal bmg approach is well tolerated and results. Despite the long history of this method, it is unclear how far the female urethra should be dilated in correlation with.
These conditions greatly impact the health and quality of life of patients. Female ureteral stricture urologists at brigham and women s hospital bwh specialize in problems of the genitourinary tract, including ureteral strictures. In adults, urethral strictures from instrumentation trauma may occur after prostate surgery and urinary catheterization. A ureteral stricture is a narrowing of the ureter that causes an obstruction in the flow of urine. Management of urethral stricture in women request pdf. The clinical guideline on male urethral stricture provides a clinical framework for the diagnosis of urethral stricture and includes discussion of diagnosis and initial management, urethroplasty, reconstruction, contracture, stenosis, special circumstances, and postoperative followup care. Pdf surgical management of female urethral strictures. This was a retrospective study of female urethral strictures identified from a database of patients seen at a. The treatment of complex female urethral pathology.
Controlled clinical trials are unusual in surgery, rare in urology, and almost nonexistent as far as the management of urethral stricture is concerned. Urethral stricture in men management and treatment. Surgical management delayed management abstract context. Smith division of urology, hospital of the university of pennsylvania, philadelphia, pennsylvania and the department of urology, medical university of south carolina, charleston, south carolina, usa. Dorsal onlay vaginal mucosal graft urethroplasty for refractory. Underlying conditions like infections and inflammation may also be treated at the same time. Management of urethral strictures stenosis is complex and requires careful evaluation. This condition occurs in up to 600 out of every 100,000 men, 2.
The principle of treatment of urethral strictures is to restore and maintain the luminal diameter for as long as possible. Strictures were located in the posterior urethra with or without bulbar urethral involvement in 50% of cases 10, the bulbomembranous urethra in 35% 7, the bulbar urethra in 10% 2, and the proximal pendulous urethra in 5% 1 with a mean stricture length of 8. In men, its a long tube that runs through the penis. Primary bladder neck obstruction is a rare clinical entity, reported to be responsible for 2. Most female urethral strictures are treated with serial urethral dilation or internal urethrotomy. Female urethral reconstruction, current bladder dysfunction. Dec 24, 2018 urethral strictures may lead to complications, such as total blockage of the urine flow that could result in urinary retention.
Female urethral stricture disease, current urology reports. Strictures can be caused by infection, trauma, instrumentation, or prior urethral surgery. A urethral stricture is a narrowing of the urethra due to scarring caused by injury, infection, or inflammation. Thus mens urethras are more susceptible to disease or injury. Aug 19, 2016 female urethral stricture fus represents a rare condition, yet one that can cause significant, bothersome lower urinary tract symptoms luts. Dec 23, 2016 urethral stricturestenosis is a narrowing of the urethral lumen.
The urethra was dilated to 30f in 7 women and 41f in 93 women, whereas in 7 women it was unclear to what calibre dilatation was performed. Urethral strictures have multiple causes including prior urinary tract infection, catheter placement, injury to the urethra, pelvic radiation. Historically, urethral dilation has been a preferred treatment choice for these patients. Materials and methods this was a retrospective study of female urethral strictures identi. The treatment procedures for correcting urethral strictures in women may include. Female genital mutilation, on the other hand, is a common practice in the west african subregion, with up to half of the female population circumcised. Urethral strictures are more common in men because their urethras are longer than those in women. Management of urethral strictures postgraduate medical journal. It is extremely important that the site of the stricture is clearly recorded by the urologist, to ensure that appropriate instructions are given to the. The most common etiologies are traumatic injury, iatrogenic injury, and inflammatory disease resulting in periurethral fibrosis.
Use of an absorbable urethral stent for the management of a ureth ral stricture in a stallion. Urethral cancer a rare cancer that happens more often in men. Definitive repair of urethral strictures in women traditionally utilizes vaginal and labial flaps. Currently, only a small amount of literature has reported the successful treatment of female urethral stricture using a reconstruction approach. The most common pathologies of the female urethra requiring surgical treatment are urethral strictures and urethral diverticulae ud. Urethroplasty using a flap or graft augmentation is a feasible treatment for female urethral strictures with good reported success rates and a minimal risk of stress of incontinence. Urotronic offers new hope for men suffering from urethral strictures. Female urethral stricture is uncommon and difficult to diagnose. Use of an absorbable urethral stent for the management of. The treatment options for urethral stricture vary in their success rates. Definitions, diagnostic tests, and aetiology of female urethral stricture. Urethral stricture disease is associated with varying degrees of fibrosis of the spongiosum.
Imaging studies and endoscopic evaluations are important tools in. A stricture restricts the flow of urine from the bladder and can cause a variety of medical problems in the urinary tract, including inflammation or infection. Tips and tricks for difficult urethral catheterization. A contemporary series examining urethral dilation under general anaesthesia for fus in 30 women demonstrated a success rate defined as no. Management of urethral stricture in women sciencedirect.
No formal studies of urethral stricture disease incidence have been published. The condition results in difficulty while urinating, blood in the urine, abdominal pain, and even urinary incontinence. Asking men to pass a catheter into their own urethra to try to stop a urethral stricture from coming back. Patients with urethral stricture disease commonly have difficulty urinating or a weak stream. A person is rarely born with urethral strictures and women rarely develop urethral strictures. To describe the successful management of a urethra l stricture with an absorbable stent in a stallion. The techniques of urethroplasty all have a higher mean success rate 8094%.
Male urethral stricture american urological association. Female urethral injuries these often occur together with bladder ruptures and can. This can prevent obstructive symptoms caused by progressive urethral narrowing, and. Conclusion female urethral reconstruction, either vfu or dorsal bmg, is a safe and successful procedure that should be offered to women with urethral strictures. This was a retrospective study of female urethral strictures identified from a database of patients seen at a single tertiary care center from 1998 to 2010. Sanjay kulkarni talks about management of urethral strictures. At present, only expert opinion is available to guide clinical practice. The urethra is the tube that allows urine to pass out of the body. The true female urethral stricture is a rare disease made more common by widespread use of inappropriate urethral dilation. Intermittent selfcatheterisation has also been successful in the management of urethral strictures, where the catheter is not always completely inserted into the bladder but used as a dilator. In this study we describe our results with the management of female urethral stricture using a dorsal vaginal graft. Dorsal buccal mucosa graft urethroplasty for female urethral strictures. Asking men to pass a catheter into their own urethra to.
Pdf female urethral stricture fus represents a rare condition, yet one that can. A treatment of urethral stricture in women may involve cystoscopy, surgical procedures, such as urethroplasty, and the placement of a catheter if required. There is no consensus as to whether it is a clinically effective or costeffective intervention in the management of this disease. Urethra is the tube that carries urine out of the body from the bladder to the external environment.
Dorsal vaginal graft urethroplasty as a treatment for female. Outcome of women undergoing urethral dilation under anesthesia hypothesis aims of study urethral dilation has been described for use in female urethral stricture disease 1 and urethral syndrome defined as lower urinary tract symptoms luts like dysuria, frequency, and urgency without a specifically identifiable pathology. Acute urinary retention can result in damage to the kidneys. The diagnosis of female urethral stricture disease is usually based on symptoms, meatal appearance, and difficult instrumentation of the patient. The treatment of complex female urethral pathology sciencedirect. Lateralbased anterior vaginal wall flap in the treatment.
Female urethroplasty is associated with higher success rates. Urethral stricture guideline american urological association. Urotronic offers new hope for men suffering from urethral strictures u. View the article pdf and any associated supplements and figures for a period of 48 hours. Symptoms of urethral stricture can range from no symptoms at all to complete urinary retention. Preoperative patient characteristics were collected. Hence, the longterm utility of dilation and urethrotomy for urethral stricture in women.
When a scar from swelling, injury or infection blocks or slows the flow of urine in this tube, it is called a urethral stricture. Guideline statements were developed to aid the clinician in optimal evaluation, treatment, and followup of patients presenting with urethral strictures. The urethras main job in males and females is to pass urine outside the body. About 10% of women with obstructive voiding will have a true anatomical urethral. Benson, robert goldfarb, peter kirk, yongmei qin, tudor borza, ted a. Female ureteral stricture urologists at brigham and womens hospital bwh specialize in problems of the genitourinary tract, including ureteral strictures. Female urethral stricture fus is an uncommon condition.
A nationwide assessment of the emergency department management of acute urinary retention due to urethral stricture. None the less, the number of so called experts, past and present, is comparatively small and in broad principle their views more or less. Urethral stricture is an abnormal narrowing of the urethra. It has been estimated that boo accounts for between 2. These guidelines were prepared on behalf of the european association of urology eau to assist urologists in the management of traumatic urethral injuries. Dec 19, 2018 primary bladder neck obstruction is a rare clinical entity, reported to be responsible for 2. First of all, it is important to choose the right side of. The most common complication is a recurrence of the urethral stricture. Dorsal onlay vaginal graft urethroplasty for female urethral. Treatment of urethral strictures from irradiation and other. Urethral diverticulae and female urethral strictures are rare pathologies. Population analysis of male urethral stricture management. Urethral problems may happen due to aging, illness, or injury. Urethral strictures in women reconstructive urology.
Female urethral stricture disease is very rare, but can cause bothersome urinary tract symptoms. Female bladder outlet obstruction is a difficult entity to define. Female urethral stricture, urethral dilatation, urethroplasty. A urethral stricture occurs when scarring narrows the tube that carries urine out of your body. Population analysis of male urethral stricture management and urethroplasty success in the united states cooper r. Dorsal vaginal graft urethroplasty for female urethral. Successful treatment for urethral stricture endoscopic or surgical is most commonly defined as no further need for surgical intervention or instrumentation. Treatment depends upon the strictures location along the urethra, as well as its severity.
Once the diagnosis is suspected based on obstructive voiding symptoms and uroflowmetry, most clinicians will use in addition videourodynamics including urethrography, urethral calibration and cystourethroscopy for. We describe the diagnosis, management and outcome of urethral strictures in a series of women evaluated at a large referral institution. Sep 21, 20 what are the causes for urethral stricture. Urethral stricture is the term applied to abnormal narrowing of the anterior urethra, whereas the american urologic association prefers the term stenosis for narrowing of the posterior urethra, which lacks spongiosum. Further understanding of these conditions will aid in the proper diagnosis and prevent delay in management. For recurrent disease or obstruction associated with antiincontinence procedures, open urethral reconstruction and urethrolysis are required. Novel surgical technique for female distal urethral stricture disease. Treatment of urethral strictures from irradiation and. Female urethral strictures are rare but can cause severe symptoms impacting. Oct 17, 2008 female bladder outlet obstruction is a difficult entity to define, and the subset representing stricture disease may also be elusive. Therefore it is important to consider urethral pathologies as a possible cause in any case of luts in women. Any inflammation of the urethra resulting from injury, trauma, previous surgery, or infection can cause urethral stricture.
Conservative management includes dilation and internal urethrotomy. Surgical management of female urethral strictures female urethral stricture fus represents a rare condition, yet one that can cause significant, bothersome lower urinary tract symptoms luts. Symptom, treatment and advice from community members. Females who are premenopausal can also develop a urethral. It can lead to various urinary storage and voiding symptoms. First line, minimally invasive treatment consists of urethral dilation and urethrotomy, though urethrotomy is rarely performed. Dorsal vaginal graft urethroplasty as a treatment for.
Pdf female hypospadias and urethral stricture disease in. Concluding message vfu and bmg are the most promising options for the management of urethral strictures in women. This thin tube also has an important role in ejaculation for men. Line of surgical management for fsu is not well established.
Oct 17, 2008 female urethral stricture disease is a rare entity. Urotronic offers new hope for men suffering from urethral. Female bladder outlet obstruction is a difficult entity to define, and the subset representing stricture disease may also be elusive. Women with urethral strictures often present with symptoms of obstructed urinary flow, such as incomplete emptying, straining, and elevated postvoid residual.
Surgical management of female urethral strictures ncbi. A urethral stricture is a narrowing of the urethra, the tube through which urine leaves the bladder and exits the body. Urethral stricture occur predominantly in males for the male urethra is 67 times longer than the female. Urethral stricture involves constriction of the urethra. In children, urethral strictures most often follow reconstructive surgery for congenital abnormalities of the penis and urethra, cystoscopy and occasionally may be congenital. In some cases, the urethra is reconstructed by removing the scar tissue and then suturing the ends of the urethra back together, called an urethroplasty. May 17, 2012 we identified 11 women who underwent dorsal vaginal graft urethroplasty for female urethral stricture disease between 2007 and 2011. In select women vaginal flap urethroplasty and buccal mucosal graft have high success rates, including 100% at 1 year and 78% at 5 years. What data there are come largely from so called expert opinion and the quality of this is variable. Although its true incidence is largely unknown, it appears to be relatively low 1 x 1 santucci, r. Dec 18, 2011 management depends on stricture type, location, severity, length, patient preference and goals. Hallmark symptoms are frequency and urgency, and may also be dysuria, hesitancy, slow stream, incontinence, and recurrent urinary tract infections. Brandes objective to examine populationbased practice patterns and outcomes related to urethroplasty for urethral stricture management.
If dilation or urethrotomy fails and the stricture returns, urethral reconstruction may be needed to obtain a durable result in terms of opening the urethra. This is usually due to tissue inflammation or the presence of scar tissue. A urethral caruncle is the most common benign tumor that occurs in the urethra in postmenopausal women. Urethral dilation works best for people who have scarring only on the inner surface of the urethra epithelium, rather than surrounding tissues like the spongy part of the penis corpus spongiosum. Because of rarity, knowledge of how to treat true female urethral strictures can be lacking. Labial flap urethroplasty is feasible and good option for the management of young female with urethral stricture disease. Female ureteral stricture brigham and womens hospital. Female urethral stricture fus bladder outlet obstruction boo is relatively uncommon cause of lower urinary tract symptoms luts in women. To date, urethral stricture disease in men, though relatively common, represents an often poorly managed condition. Evaluation and treatment of female urethral stricture disease. The mainstay of treatment of female urethral strictures is urethral dilatation. Management of anterior urethral strictures european. Surgical management of female urethral strictures hoag.
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