V261: VENTRAL INLAY LABIUM MINUS GRAFT URETHROPLASTY FOR THE MANAGEMENT OF FEMALE URETHRAL STRICTURES
VideoIntroduction and Objectives
Urethral stricture disease is rare in women. Female urethroplasty is a topic of increasing attention with multiple surgical approaches described including use of both grafts (vaginal wall, buccal mucosal membrane, lingual mucosa, and labia minus) and flaps (vaginal vestibule, anterior and lateral vagina). We present our experience with ventral inlay labium minus graft urethroplasty (VILGU).
Five consecutive women (aged 47 to 52 years) with mid- to distal urethral strictures were treated with VILGU between 2011 and 2012. The etiology was caruncle excision in 2 and idiopathic in 3. All but one patient had previous internal urethrotomy and repeated uretheral dilatations. Two were cytostomized at the time of repair. Pre- and postoperative evaluation included assessment of voiding symptoms with AUA symptom score, uroflowmetry with residual urine determination, voiding cystourethrography (VCUG), and intraoperative urethrocystoscopy. In the surgical technique, ventral urethra was exposed through a midline anterior vaginal wall incision, the fibrotic urethra was incised from distal to proximal stricture site at six o'clock. A labium minus skin graft of 2.5-3 cm in length and 1-1.5 cm in width was harvested and augmented to the urethra as ventral inlay on a 20-22 Fr catheter with running 4/0 absorbable suture. Catheter was removed after 2 weeks. Postoperative follow-up was scheduled at 1st, 3rd, 6th months, and yearly thereafter. Cure was defined as the absence of any re-stenosis requiring additional intervention with subjective patient satisfaction.
Mean operative time was 95 minutes (70-110 min.). With a mean follow-up of 13.6 months (range: 6 to 20) cure was achieved in all patients. At the last follow-up, mean Qmax (ml/sec) increased from 3.8±3.2 preoperatively to 22.9±6.5 postoperatively (p