Neurourology and Urodynamics 34:213–218 (2015)
Vestibular Flap Urethroplasty in Women With Recurrent Distal Intramural Urethral Pathology Adam Romman, Liz Takacs, Jason Gilleran, and Philippe Zimmern* UT Southwestern Medical Center, Dallas, Texas Introduction: To report our experience with vestibular flap urethroplasty in case of recurrence of distal intramural urethral pathology (DIU) after unsuccessful urethral dilation under anesthesia. Methods: Following Independent Review Board approval, charts of non-neurogenic women who underwent urethroplasty for DIU were reviewed. Vestibular flap urethroplasty was offered to patients who failed one or two dilations. Success was defined as improvement on the single quality of life questionnaire (QoL, rated 1–10) with either a final score three or less, or a decrease of four QoL points from baseline and no related repeat procedure at any time during follow-up, with a minimum follow-up at 6 months. Results: From 1998 to 2012, 28/30 patients had adequate follow-up and 19 met the criteria for success. Mean age at time of urethroplasty was 51 in both the success and failure groups. Mean follow-up was 52 49 months in the success group and mean time to failure was 17 20 months in the failure group. Mean QoL in the success group improved from 7.0 2.1 preoperatively to 2.0 1.7 postoperatively. Mean QoL in the failure group did not improve (from 7.0 1.6 to 6.4 1.5). Urethral wall fibrosis was confirmed in all tissue samples excised. No patient experienced new onset or exacerbation of stress urinary incontinence. Failure group was managed by repeat urethroplasty, clean intermittent catheterization or other methods. Conclusion: Vestibular flap urethroplasty is a viable long-term treatment option in women with DIU who have failed at least one dilation. Neurourol. Urodynam. 34:213–218, 2015. # 2014 Wiley Periodicals, Inc. Key words: dilatation; distal urethroplasty; female; lower urinary tract symptoms; urethra
INTRODUCTION
The incidence of bladder outlet obstruction in women related to all etiologies has been estimated at 2.7–8% of women with complaints of lower urinary tract symptoms.1 Most obstructed women present after an anti-incontinence procedure. However, some may have obstruction from other etiologies including urethral disease such as urethral stricture, distal urethral intramural pathology (DIU), or even large circumferential urethral diverticuli.2,3 Urethral stricture definitions vary, with a calibration
Vestibular Flap Urethroplasty in Women With Recurrent Distal Intramural Urethral Pathology Adam Romman, Liz Takacs, Jason Gilleran, and Philippe Zimmern* UT Southwestern Medical Center, Dallas, Texas Introduction: To report our experience with vestibular flap urethroplasty in case of recurrence of distal intramural urethral pathology (DIU) after unsuccessful urethral dilation under anesthesia. Methods: Following Independent Review Board approval, charts of non-neurogenic women who underwent urethroplasty for DIU were reviewed. Vestibular flap urethroplasty was offered to patients who failed one or two dilations. Success was defined as improvement on the single quality of life questionnaire (QoL, rated 1–10) with either a final score three or less, or a decrease of four QoL points from baseline and no related repeat procedure at any time during follow-up, with a minimum follow-up at 6 months. Results: From 1998 to 2012, 28/30 patients had adequate follow-up and 19 met the criteria for success. Mean age at time of urethroplasty was 51 in both the success and failure groups. Mean follow-up was 52 49 months in the success group and mean time to failure was 17 20 months in the failure group. Mean QoL in the success group improved from 7.0 2.1 preoperatively to 2.0 1.7 postoperatively. Mean QoL in the failure group did not improve (from 7.0 1.6 to 6.4 1.5). Urethral wall fibrosis was confirmed in all tissue samples excised. No patient experienced new onset or exacerbation of stress urinary incontinence. Failure group was managed by repeat urethroplasty, clean intermittent catheterization or other methods. Conclusion: Vestibular flap urethroplasty is a viable long-term treatment option in women with DIU who have failed at least one dilation. Neurourol. Urodynam. 34:213–218, 2015. # 2014 Wiley Periodicals, Inc. Key words: dilatation; distal urethroplasty; female; lower urinary tract symptoms; urethra
INTRODUCTION
The incidence of bladder outlet obstruction in women related to all etiologies has been estimated at 2.7–8% of women with complaints of lower urinary tract symptoms.1 Most obstructed women present after an anti-incontinence procedure. However, some may have obstruction from other etiologies including urethral disease such as urethral stricture, distal urethral intramural pathology (DIU), or even large circumferential urethral diverticuli.2,3 Urethral stricture definitions vary, with a calibration
