2022 - Lesson 22 Female Urethral Stricture

Question 1

Female urethral stricture

Question 2

What is the normal caliber of the female urethra?

Answer 2

22F (18F - 28F 95% CI)

Question 3

Name two types of flap urethroplasty techniques for female urethral reconstruction.

Answer 3

Blandy and Orandi techniques.

Question 4

What are the main categories of voiding dysfunction?

Answer 4

Detrusor underactivity (DU) and bladder outflow obstruction (BOO).

Question 5

What percentage of female urethral stricture cases are considered idiopathic?

Answer 5

44%-51% (Referenced from the etiology statistics)

Question 6

What are the key symptoms associated with Female Urethral Stricture (FUS)?

Answer 6

Slow flow, incomplete bladder emptying, urine spraying, hesitancy, straining, dysuria, acute urinary retention, elevated residual urine, frequency, urinary incontinence, recurrent UTIs, hematuria, and urethral pain.

Question 7

How is the buccal graft harvested for urethroplasty?

Answer 7

The graft is marked to the desired length, hydrodissected using lidocaine with epinephrine, incised at the edges, and then dissected free from underlying tissues.

Question 8

What is the first documented report of Female Urethral Stricture (FUS)?

Answer 8

The first reported case of FUS was in 1828.

Question 9

What are the main reported causes of FUS?

Answer 9

Iatrogenic injury, trauma, urinary tract infections (UTIs), inflammation, catheter-related inflammation, and surgeries like diverticulectomy, mesh removal, radiation, vaginal reconstruction, and female genital mutilation.

Question 10

What is the importance of cystoscopy under anesthesia in diagnosing FUS?

Answer 10

Cystoscopy under anesthesia is valuable in instances of diagnostic uncertainty.

Question 11

Describe the three stages of uroflowmetry results presented in the document for diagnosing urethral stricture.

Answer 11

Initial low flow with elevated PVR, return to bell-shaped curve post-dilation, and recurrence with plateau/mesa-shaped uroflow.

Question 12

What are the recommended options for repeated endoscopic treatment of extensive or recurrent FUS?

Answer 12

Repeated endoscopic treatment is generally not recommended for extensive or recurrent strictures due to high recurrence rates.

Question 13

Which graft is most commonly used in female urethral reconstruction?

Answer 13

Buccal mucosa is the majority of oral grafts used in female urethral reconstruction.

Question 14

What is the recurrence-free rate at 12 months for women undergoing vaginal flap urethroplasty with either an advancement flap (Blandy) or tubularized flap (Orandi)?

Answer 14

77% of women were recurrence-free at 12 months.

Question 15

What is the preferred catheter size and duration of catheterization postoperatively according to the document?

Answer 15

Nonlatex, 16Fr-18Fr urethral catheters for a duration of about 14 days.

Question 16

What are the common surgical reconstruction options for Female Urethral Stricture (FUS)?

Answer 16

Options include urethral dilation, urethrotomy, urethroplasty (ventral, dorsal, combined), flap urethroplasty (Blandy, Orandi), and graft urethroplasty using buccal mucosa.

Question 17

When is urethral dilation considered as a treatment for FUS?

Answer 17

Urethral dilation is used to stretch the lumen without worsening scarring, typically for less extensive strictures.

Question 18

Describe the Blandy technique for flap urethroplasty.

Answer 18

The Blandy technique involves an inverted U incision in the anterior vaginal wall, flap development, incision, calibration, suturing, and closure.

Question 19

What are the considerations for selecting the appropriate surgical approach for a urethral stricture?

Answer 19

Considerations include stricture characteristics (location, length, etiology), patient goals and preferences, surgeon expertise, and available techniques.

Question 20

What are the challenges and recommendations specific to female urethrotomy?

Answer 20

Urethrotomy involves incision of the urethral scar tissue and can be performed with a cold knife, electrocautery, or laser. Challenges include the specificity of the female urethra and careful consideration of the type and location of the stricture.

Question 21

When is graft urethroplasty using buccal mucosa considered for FUS?

Answer 21

Graft urethroplasty, predominantly using buccal mucosa, is considered in more complex cases of reconstruction and adapts methods used in male urethral reconstruction.

Question 22

What are the potential complications of anterior vaginal flap urethroplasty (“Blandy”)?

Answer 22

Potential complications include spraying urinary stream and vaginal voiding.

Question 23

What are the common symptoms of a Female Urethral Stricture (FUS)?

Answer 23

Symptoms can include slow flow, incomplete bladder emptying, urine spraying, hesitancy, straining, dysuria, acute urinary retention, elevated residual urine, frequency, urinary incontinence, recurrent UTIs, hematuria, and urethral pain.

Question 24

What are the typical findings of overactive bladder?

Answer 24

Overactive bladder is characterized by symptoms of urinary urgency, frequency, and urgency incontinence, often without an obvious cause

Question 25

What is a Skene’s duct cyst, and what are its typical symptoms?

Answer 25

A Skene’s duct cyst is a benign cyst located near the urethra, often asymptomatic but can cause dysuria or urinary frequency if large.

Question 26

What is pseudo detrusor sphincter dyssynergia, and how is it diagnosed?

Answer 26

Pseudo detrusor sphincter dyssynergia is a condition where the urinary sphincter muscle does not relax properly during voiding. Diagnosis usually involves urodynamic testing, and symptoms may include difficulty urinating and high post-void residual volumes.

Question 27

What is the significance of a normal uroflow with a maximum flow rate of 25 mL/s and a post-void residual of 30 mL?

Answer 27

A normal flow rate and low post-void residual indicate normal bladder emptying and are not typical for conditions that cause obstruction or significant retention.

Question 28

What are the limitations of endoscopic dilation for treating Female Urethral Stricture (FUS)?

Answer 28

Endoscopic dilation has minimal risks but high recurrence rates, especially for extensive or recurrent strictures.

Question 29

Describe the Blandy procedure (anterior vaginal mucosal flap urethroplasty) and its typical applications.

Answer 29

The Blandy technique involves an inverted U incision in the anterior vaginal wall, flap development, and closure. It’s used for anterior vaginal flap urethroplasty but may have complications like spraying urinary stream and vaginal voiding.

Question 30

What is a buccal graft dorsal urethroplasty, and when is it used?

Answer 30

Buccal graft dorsal urethroplasty involves using a graft from the mouth (buccal mucosa) placed on the dorsal side of the urethra. It’s used for more complex reconstructions and can be considered when other methods have failed.

Question 31

When is a buccal or vaginal graft ventral urethroplasty considered?

Answer 31

Buccal or vaginal graft ventral urethroplasty involves placing a graft on the ventral side of the urethra. It may be suitable when there’s a lack of ventral urethral plate or when other methods like flap techniques have failed.

Question 32

What are meatotomies, and why might they not be suitable for the given scenario?

Answer 32

Meatotomy involves an incision of the urethra at 6 o’clock rather than excision of the distal urethra. It may not be suitable for recurrent strictures following several procedures, as described in the question.