A recent article by A. Tsivian and A. A. Sidi from Tel Aviv University in Israel reports on the results of a dorsal vaginal or buccal mucosa graft used in three women with urethral strictures. The report is published in the August 2006 issue of the Journal of Urology.

The three patients were 60 year-old women who had undergone multiple urethral dilations and internal urethrotomies for a history of recurrent urinary tract infections and obstructive voiding symptoms. All patients were utilizing intermittent self-catherization during the 2 to 4 years before agreeing to undergo corrective surgery with a dorsal onlay graft urethroplasty.

The operative procedure involved urethral catheterization with a 6Fr ureteral catheter and a suprameatal incision. The dorsal aspect of the urethra was dissected from the surrounding tissue and the urethral wall was opened at 12 o'clock until healthy urethral tissue was encountered. The incision length ranged from 2 to 3 cm from the meatus. A 1.5 cm wide free graft of either vaginal wall in 2 patients and buccal mucosa in 1 patient was placed upon the urethral lumen and sutured in place with a running 5-zero polyglactin sutured to open the urethral edges. An indwelling 18Fr urethral catheter and a 16Fr suprapubic catheter were left in place for 2 and 3 weeks, respectively.

Results showed that normal micturition was achieved after catheter removal and during follow-up of 1, 8 and 27 months. No additional treatment was required and cystoscopy 3 months after surgery showed good urethral patentcy. No stress incontinence was reported.

This technique is feasible, simple, safe and effective and should be considered for the correction of female urethral stricture disease.

J Urol. 2006 August;176(1):611-13

Written by Michael J. Metro, MD, a Contributing Editor with UroToday.

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