V2-07: Female Urethroplasty with Buccal Mucosal Graft for Stricture Disease
Female urethral strictures are rare and occur in less than 1% of women. Common causes are trauma, iatrogenic injury, inflammatory diseases or idiopathic. Diagnosis is suspected when a patient reports obstructive symptoms, urodynamics shows outlet obstruction and/or cystourethroscopy reveals urethral narrowing or fibrosis. Surgical treatment depends on location and length of the stricture, and the optimal approach is not well established. In this video, the technique for female urethroplasty with a dorsal onlay buccal mucosal graft is demonstrated.
A 48-year-old female patient presented with long-standing, symptomatic urethral stricture disease. She previously failed conservative management with urethral dilations and elected to pursue urethroplasty with buccal mucosal graft. Following informed consent, video recording of intraoperative surgical procedure was performed. Video editing and narration was standardized to highlight key steps of the procedure.
The patient was taken to the OR for urethroplasty with a dorsal onlay buccal mucosal graft. First, a cystoscopy was performed and a suprapubic tube was placed to allow for sufficient postoperative healing. The buccal mucosal graft was harvested, defatted and soaked in normal saline. Circumferentially around the urethral meatus hydrodissection is used with care taken to avoid the clitoral tissue and nerves. The urethra was dissected to the level of the bladder neck and the full extent of the stricture was identified then incised. Stay sutures were placed in the superior and inferior apices to facilitate placement of the graft. Superior apical sutures were threaded through the graft and additional interrupted sutures were placed circumferentially. The graft was trimmed to size, threaded with the inferior apical stay sutures and secured in place. The surgical bed and graft were joined to enhance revascularization. The patient did well postoperatively, with no recurrence of stricture and healthy buccal mucosa graft on cystoscopy.
Urethroplasty with dorsal buccal mucosal graft placement can be a feasible and effective treatment for female urethral strictures.