Transurethral dorsal buccal graft urethroplasty for proximal female urethral strictures

Dec. 13, 2022

Historically, treatment options for mid and proximal urethral strictures had significant limitations. Urethral dilation, while minimally invasive, has recurrence rates of 50% or more, with decreasing success over time and re-treatment being the norm. Other reconstructive techniques for placing a dorsal graft have included a suprameatal incision and full thickness incision of the urethra, increasing the technical difficulty and risk of developing stress urinary incontinence.

Brian J. Linder, M.D., and Nicholas Warner, M.D., urologists at Mayo Clinic in Rochester, Minnesota, have used a novel transurethral approach to dorsal buccal graft urethroplasty for managing proximal female urethral strictures. Their technique — recently published in the International Urogynecology Journal — captures the durability of a buccal graft urethroplasty and minimizes the morbidity of the suprameatal dissection.

The procedure takes roughly 60 minutes, and discharge is the same day. The procedure occurs transurethrally with use of a nasal speculum, incision of the stricture and securing a buccal graft along the entire length of the urethra using a suture-passing device. A transurethral catheter stays in place for three weeks to allow for graft healing. Patients are seen at three months for cystoscopy and to follow up on their symptoms.

Dr. Linder says, "Early results have been promising, with successful resolution of the strictures in patients, even among those who had been undergoing serial urethral dilations for years."

Unlike other versions of female urethroplasty, de novo stress urinary incontinence has been rare. Dr. Warner adds, "By minimizing the dissection, we can really avoid longer operations and complications without compromising the outcomes." With the early successes identified, additional cases and longer follow-up are needed to further assess the technique.

For more information

Linder BJ, et al. Transurethral dorsal buccal graft urethroplasty for proximal female urethral strictures. International Urogynecology Journal. 2022;33:2317.

Refer a patient to Mayo Clinic.