Female urethral stricture disease is rare and has several surgical approaches including endoscopic dilations (ENDO), urethroplasty with local vaginal tissue flap (ULT) or urethroplasty with free graft (UFG). This study aims to describe the contemporary management of female urethral stricture disease and to evaluate the outcomes of these three surgical approaches.
This is a multi-institutional, retrospective cohort study evaluating operative treatment for female urethral stricture. Surgeries were grouped into three categories: ENDO, ULT, and UFG. Time from surgery to stricture recurrence by surgery type was analyzed using a Kaplan-Meier time to event analysis. To adjust for confounders, a Cox proportional hazard model was fit for time to stricture recurrence.
Two-hundred and ten patients met the inclusion criteria across 23 sites. Overall, 64% (n = 115/180) of women remained recurrence free at median follow-up of 14.6 months (IQR, 3-37). In unadjusted analysis, recurrence-free rates differed between surgery categories with 68% ENDO, 77% UFG and 83% ULT patients being recurrence free at 12 months. In the Cox model, recurrence rates also differed between surgery categories; women undergoing ULT and UFG having had 66% and 49% less risk of recurrence, respectively, compared to those undergoing ENDO. When comparing ULT to UFG directly, there was no significant difference of recurrence.
This retrospective multi-institutional study of female urethral stricture demonstrates that patients undergoing endoscopic management have a higher risk of recurrence compared to those undergoing either urethroplasty with local flap or free graft.
Neurourology and urodynamics. 2020 Sep 14 [Epub ahead of print]
Giulia I Lane, Ariana L Smith, Hanna Stambakio, George Lin, Omar Al Hussein Alawamlh, Jennifer T Anger, Eileen R Brandes, Maude E Carmel, Doreen E Chung, Lindsey Cox, Jessica DeLong, Christopher S Elliott, Ehab Eltahawy, Wagner Aparecido França, Angelo Gousse, Priyanka Gupta, Judith C Hagedorn, Rachel A High, Aqsa Khan, Casey Kowalik, Richard K Lee, Una J Lee, Alvaro Lucioni, Susan MacDonald, Bahaa Malaeb, Scotty McKay, Priya Padmanabhan, Charles R Powell, Kamran P Sajadi, Suzette E Sutherland, Didi Theva, Annah Vollstedt, Blayne Welk, Yu Zheng, Anne P Cameron, Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction Research Network (SURN)
Department of Urology, University of Michigan, Ann Arbor, Michigan, USA., Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania, USA., Department of Urology, Weill Cornell Medicine, NYC, New York, USA., Department of Urology, Cedars-Sinai, Beverly Hills, California, USA., Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA., Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA., Department of Urology, Columbia University, NYC, New York, USA., Department of Urology, Medical University of South Carolina, Charleston, South Carolina, USA., Department of Urology, Eastern Virginia Medical School, Norfolk, Virginia, USA., Department of Urology, Santa Clara Valley Medical Center, San Jose, California, USA., Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA., Department of Urology, Hospital do Servidor Público Estadual de São Paulo - IAMSPE, São Paulo, Brazil., Department of Urology, Memorial Hospital Miramar, Miramar, Florida, USA., Department of Urology, University of Washington, Seattle, Washington, USA., Department of Urology, Baylor Scott and White Health, Temple, Texas, USA., Department of Urology, Mayo Clinic, Phoenix, Arizona, USA., Department of Urology, Kansas University Medical Center, Kansas City, Kansas, USA., Department of Urology, Virginia Mason, Seattle, Washington, USA., Division of Urology, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA., Department of Urology, Beaumont Hospital, Royal Oak, Michigan, USA., Department of Urology, Indiana University, Indianapolis, Indiana, USA., Department of Urology, Oregon Health & Science University, Portland, Oregon, USA., Division of Urology, Western University, London, Ontario, Canada.