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Etiology and Evaluation of Female Urethral Strictures

  • Voiding Dysfunction Evaluation (B Brucker and B Peyronnet, Section Editors)
  • Published:
Current Bladder Dysfunction Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This goal of this review is to summarize the current literature on the diagnosis and evaluation of female urethral stricture.

Recent Findings

Female urethral stricture is a rare condition, which can present with a wide variety of symptoms, including both obstructive and irritative voiding symptoms, pain, or infection. Initial evaluation with post-void residual and uroflowmetry are good screening tests but are unable to diagnose stricture. Diagnosis often requires more than one modality, most commonly cystoscopy and voiding cystourethrogram, with or without urodynamics. Ultrasound is a newer diagnostic tool that can aid in diagnosis and surgical planning.

Summary

Female urethral stricture is a rare pathology and requires a high-clinical suspicion for accurate diagnosis. While there is a lack of consensus on clear diagnostic criteria, multiple modalities are often used to establish a diagnosis.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Osman NI, Chapple CR. Contemporary surgical management of female urethral stricture disease. Curr Opin Urol. 2015;25:341–5.

    Article  Google Scholar 

  2. Smith AL, Ferlise VJ, Rovner ES. Female urethral strictures: successful management with long-term clean intermittent catheterization after urethral dilatation. BJU Int. 2006;98:96–9.

    Article  Google Scholar 

  3. Osman NI, Mangera A, Chapple CR. A systematic review of surgical techniques used in the treatment of female urethral stricture. Eur Urol. 2013;64:965–73.

    Article  Google Scholar 

  4. West C, Lawrence A. Female urethroplasty: contemporary thinking. World J Urol. 2019;37:619–29.

    Article  CAS  Google Scholar 

  5. Waterloos M, Verla W. Female urethroplasty: a practical guide emphasizing diagnosis and surgical treatment of female urethral stricture disease. BioMed Res Int. 2019;2019:e6715257.

    Article  Google Scholar 

  6. Wessells H, Angermeier KW, Elliott S, et al. Male urethral stricture: American Urological Association Guideline. J Urol. 2017;197:182–90.

    Article  Google Scholar 

  7. Spilotros M, Malde S, Solomon E, Grewal M, Mukhtar BM, Pakzad M, Hamid R, Ockrim JL, Greenwell TJ. Female urethral stricture: a contemporary series. World J Urol. 2017;35:991–5.

    Article  CAS  Google Scholar 

  8. Hampson LA, Mcaninch JW, Breyer BN. Male urethral strictures and their management. Nat Rev Urol. 2014;11:43–50.

    Article  Google Scholar 

  9. Agochukwu-Mmonu N, Srirangapatanam S, Cohen A, Breyer B. Female urethral strictures: review of diagnosis, etiology, and management. Curr Urol Rep. 2019;20:74.

    Article  Google Scholar 

  10. •• Sarin I, Narain TA, Panwar VK, Bhadoria AS, Goldman HB, Mittal A. Deciphering the enigma of female urethral strictures: a systematic review and meta-analysis of management modalities. Neurourol Urodyn. 2021;40:65–79. Meta-analysis to identify the best diagnostic methods and surgical outcomes for female urethral strictures.

    Article  Google Scholar 

  11. Faiena I, Koprowski C, Tunuguntla H. Female urethral reconstruction. J Urol. 2016;195:557–67.

    Article  Google Scholar 

  12. Patel DN, Fok CS, Webster GD, Anger JT. Female urethral injuries associated with pelvic fracture: a systematic review of the literature. BJU Int. 2017;120:766–73.

    Article  Google Scholar 

  13. Anast J, Brandes SB, Klutke C. Female urethral reconstruction. In: Brandes SB, editor. Urethral Reconstr. Surg. Totowa: Humana Press; 2008. p. 303–13.

    Chapter  Google Scholar 

  14. Blaivas JG. Vaginal flap urethral reconstruction: an alternative to the bladder flap neourethra. J Urol. 1989;141:542–5.

    Article  CAS  Google Scholar 

  15. Blaivas JG, Sandhu J. Urethral reconstruction after erosion of slings in women. Curr Opin Urol. 2004;14:335–8.

    Article  Google Scholar 

  16. Heidari F, Abbaszadeh S, Ghadian A, Tehrani Kia F. On demand urethral dilatation versus intermittent urethral dilatation: results and complications in women with urethral stricture. Nephro-Urol Mon. 2014. https://doi.org/10.5812/numonthly.15212.

    Article  Google Scholar 

  17. Santucci RA, Payne CK, Anger JT, Saigal CS, Urologic Diseases in America Project. Office dilation of the female urethra: a quality of care problem in the field of urology. J Urol. 2008;180:2068–75.

    Article  Google Scholar 

  18. Brucker BM. Female urethral stricture. Rev Urol. 2018;20:174–6.

    PubMed  PubMed Central  Google Scholar 

  19. Blaivas JG, Santos JA, Tsui JF, Deibert CM, Rutman MP, Purohit RS, Weiss JP. Management of urethral stricture in women. J Urol. 2012;188:1778–82.

    Article  Google Scholar 

  20. Meyrick Thomas RH, Ridley CM, McGibbon DH, Black MM. Lichen sclerosus et atrophicus and autoimmunity–a study of 350 women. Br J Dermatol. 1988;118:41–6.

    Article  CAS  Google Scholar 

  21. Belsante MJ, Selph JP, Peterson AC. The contemporary management of urethral strictures in men resulting from lichen sclerosus. Transl Androl Urol. 2015;4:22–8.

    PubMed  PubMed Central  Google Scholar 

  22. Levy A, Browne B, Fredrick A, Stensland K, Bennett J, Sullivan T, Rieger-Christ KM, Vanni AJ. Insights into the pathophysiology of urethral stricture disease due to lichen sclerosus: comparison of pathological markers in lichen sclerosus induced strictures vs nonlichen sclerosus induced strictures. J Urol. 2019;201:1158–63.

    Article  Google Scholar 

  23. Ackerman AL, Blaivas J, Anger JT. Female Urethral Reconstruction. Curr Bladder Dysfunct Rep. 2010;5:225–32.

    Article  Google Scholar 

  24. Elliott CS. Female urethral stricture management: the initial experience of an female pelvic medicine and reconstructive surgery-trained urologist. Female Pelvic Med Reconstr Surg. 2020. https://doi.org/10.1097/SPV.0000000000000969.

    Article  PubMed  Google Scholar 

  25. • Kocadag H, Toia B, Axell R, Yasmin H, Pakzad MH, Hamid R, Greenwell TJ, Ockrim JL. A comparison of flow rate curve shape and video-urodynamic findings in women with lower urinary tract symptoms: can flow rate curve shape predict female bladder outflow obstruction or detrusor underactivity? World J Urol. 2020. https://doi.org/10.1007/s00345-020-03343-4. Retrospective study correlating uroflowmetry curves to types of bladder outlet obstruction, enhancing screening utility of uroflowmetry for urethral stricture.

    Article  PubMed  Google Scholar 

  26. • Sussman RD, Kozirovsky M, Telegrafi S, Peyronnet B, Palmerola R, Smilen S, Pape DM, Rosenblum N, Nitti VW, Brucker BM. Gel-infused translabial ultrasound in the evaluation of female urethral stricture. Female Pelvic Med Reconstr Surg. 2019. https://doi.org/10.1097/SPV.0000000000000699. Case series describing a novel technique for diagnosis female urethral stricture using gel-infused translabial ultrasound.

    Article  Google Scholar 

  27. Winters JC, Dmochowski RR, Goldman HB, et al. Urodynamic studies in adults: AUA/SUFU guideline. J Urol. 2012;188:2464–72.

    Article  Google Scholar 

  28. Marks BK, Goldman HB. Videourodynamics: indications and technique. Urol Clin North Am. 2014;41:383–91.

    Article  Google Scholar 

  29. Lim CS, Abrams P. The Abrams-Griffiths nomogram. World J Urol. 1995;13:34–9.

    Article  CAS  Google Scholar 

  30. Griffiths D, Höfner K, van Mastrigt R, Rollema HJ, Spångberg A, Gleason D. Standardization of terminology of lower urinary tract function: pressure-flow studies of voiding, urethral resistance, and urethral obstruction. International Continence Society Subcommittee on Standardization of Terminology of Pressure-Flow Studies. Neurourol Urodyn. 1997;16:1–18.

    Article  CAS  Google Scholar 

  31. Massey JA, Abrams PH. Obstructed voiding in the female. Br J Urol. 1988;61:36–9.

    Article  CAS  Google Scholar 

  32. Chassagne S, Bernier PA, Haab F, Roehrborn CG, Reisch JS, Zimmern PE. Proposed cutoff values to define bladder outlet obstruction in women. Urology. 1998;51:408–11.

    Article  CAS  Google Scholar 

  33. • Solomon E, Yasmin H, Duffy M, Rashid T, Akinluyi E, Greenwell TJ. Developing and validating a new nomogram for diagnosing bladder outlet obstruction in women. Neurourol Urodyn. 2018;37:368–378. Created and validated nomogram specifically for women with bladder outlet obstruction.

    Article  Google Scholar 

  34. Hsiao S-M, Lin H-H, Kuo H-C. Videourodynamic studies of women with voiding dysfunction. Sci Rep. 2017;7:6845.

    Article  Google Scholar 

  35. Santucci R, Chen M. Evaluation and treatment of female urethral stricture disease. Curr Bladder Dysfunct Rep. 2013;8:123–7.

    Article  Google Scholar 

  36. Chaudhari VV, Patel MK, Douek M, Raman SS. MR imaging and US of female urethral and periurethral disease. Radiographics. 2010;30:1857–74.

    Article  Google Scholar 

  37. Bhatt S, Goel M, Gupta A, Tandon A, Roy S. Diagnosis of urethral stricture on dynamic voiding transvaginal sonourethrography: a case report. J Diagn Med Sonogr. 2017;33:140–3.

    Article  Google Scholar 

  38. Dwarkasing RS, Verschuuren SI, Leenders GJLH, Thomeer MGJ, Dohle GR, Krestin GP. Chronic lower urinary tract symptoms in women: classification of abnormalities and value of dedicated MRI for diagnosis. Am J Roentgenol. 2013;202:W59–66.

    Article  Google Scholar 

  39. Surabhi VR, Menias CO, George V, Siegel CL, Prasad SR. Magnetic resonance imaging of female urethral and periurethral disorders. Radiol Clin N Am. 2013;51:941–53.

    Article  Google Scholar 

  40. Aldamanhori R, Inman R. The treatment of complex female urethral pathology. Asian J Urol. 2018;5:160–3.

    Article  Google Scholar 

  41. •• Lane GI, Smith AL, Stambakio H, et al. Treatment of urethral stricture disease in women: a multi-institutional collaborative project from the SUFU research network. Neurourol Urodyn. 2020;39:2433–2441. One of the largest, multi-institutional retrospective studies evaluating diagnosis, etiology and surgical management of urethral strictures.

    Article  Google Scholar 

  42. Horbach SER, Bouman M-B, Smit JM, Özer M, Buncamper ME, Mullender MG. Outcome of Vaginoplasty in Male-to-female transgenders: a systematic review of surgical techniques. J Sex Med. 2015;12:1499–512.

    Article  Google Scholar 

  43. Waterloos M, Hollebosch S, Verla W, Spinoit A-F, Hoebeke P, Monstrey S, Lumen N. Neo-vaginal advancement flaps in the treatment of urethral strictures in transwomen. Urology. 2019;129:217–22.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, MedStar Georgetown University Hospital, 3800 Reservoir Road, NW-1 PHC, Washington, DC, 20007, USA

    Joanna Marantidis & Rachael D. Sussman

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  1. Joanna Marantidis
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Contributions

Joanna Marantidis performed the literature review and drafted the work. Rachael Sussman critically revised the work.

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Correspondence to Joanna Marantidis.

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This article is part of the Topical Collection on Voiding Dysfunction Evaluation

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Marantidis, J., Sussman, R.D. Etiology and Evaluation of Female Urethral Strictures. Curr Bladder Dysfunct Rep 17, 13–19 (2022). https://doi.org/10.1007/s11884-021-00637-0

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