Herforth Christine, Sze Christina, Souders Colby, Christie Alana, Lemack Gary, Carmel Maude
Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
Department of Urology, The University of Kansas Medical Center, 2060 W 39th Ave, Kansas City, KS, 66103, USA.
Int Urol Nephrol. 2025 Sep 23. doi: 10.1007/s11255-025-04765-y.
Female urethral strictures (FUS) present with nonspecific urinary symptoms and are often initially managed with urethral dilation despite poor long-term efficacy. Buccal mucosa graft (BMG) urethroplasty remains underutilized in the treatment of FUS. We report our early and medium-term outcomes using dorsal-onlay BMG urethroplasty for FUS.
A retrospective review of 25 women treated with BMG urethroplasty for FUS was performed. All patients had a voiding cystourethrogram three weeks postoperatively. Success was defined as low post-void residuals and not requiring further interventions for FUS. Recurrence was diagnosed by cystoscopy.
The median patient age was 55 (45-61) years. Most common presenting symptoms included obstructive voiding (70%) and urinary retention (56%). Stricture etiology was mostly unknown (47%). Most patients had previous urethral dilation(s) (71%) and one patient had a prior urethroplasty with vestibule flap. Median stricture length was 2 (2-3) cm and most involved the distal urethra (67%). Median follow-up was 12 (3-45) months. Five patients had stricture recurrence (20%) further managed with intermittent catheterization (2), urethral dilation (1), or direct visual urethrotomy (2). Median time to recurrence was 9 months (5-33) months. There were no cases of de novo stress urinary incontinence and patient-reported outcomes showed no significant change, though data were limited.
BMG urethroplasty is an effective treatment for FUS with promising outcomes at medium-term follow-up. Irritative urinary symptoms may persist despite obstruction relief for which patients must be counseled of preoperatively. De novo SUI was not observed. The timing of stricture recurrence varies, highlighting the need for long-term follow-up.
女性尿道狭窄（FUS）表现为非特异性尿路症状，尽管长期疗效不佳，但最初常采用尿道扩张术进行治疗。颊黏膜移植（BMG）尿道成形术在FUS治疗中的应用仍未得到充分利用。我们报告了使用背侧覆盖BMG尿道成形术治疗FUS的早期和中期结果。
对25例接受BMG尿道成形术治疗FUS的女性患者进行回顾性分析。所有患者术后3周均进行了排尿性膀胱尿道造影。成功定义为排尿后残余尿量少且无需对FUS进行进一步干预。通过膀胱镜检查诊断复发情况。
患者中位年龄为55（45 - 61）岁。最常见的症状包括排尿梗阻（70%）和尿潴留（56%）。狭窄病因大多不明（47%）。大多数患者曾接受过尿道扩张术（71%），1例患者曾接受过前庭皮瓣尿道成形术。中位狭窄长度为2（2 - 3）cm，大多数累及尿道远端（67%）。中位随访时间为12（3 - 45）个月。5例患者出现狭窄复发（20%），进一步采用间歇性导尿（2例）、尿道扩张（1例）或直视下尿道切开术（2例）进行处理。复发的中位时间为9个月（5 - 33）个月。无新发压力性尿失禁病例，尽管数据有限，但患者报告的结果显示无显著变化。
BMG尿道成形术是治疗FUS的有效方法，中期随访结果良好。尽管梗阻缓解，但刺激性尿路症状可能持续存在，术前必须向患者说明这一点。未观察到新发SUI。狭窄复发的时间各不相同，这凸显了长期随访的必要性。
