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