Skip to main content

Female Urethral Reconstruction

  • Living reference work entry
  • First Online:
Female Genitourinary and Pelvic Floor Reconstruction

Abstract

Female urethral reconstruction encompasses a variety of different entities including female urethral stricture (FUS), female urethral diverticulum (FUD), and vesicovaginal fistula (VVF). Although very different in their etiologies, they all have in common a vague and nonspecific onset of symptoms and, usually, a delayed diagnosis. Once identified and evaluated, urologists must review management options with the patient which range from minimally invasive procedures to complex reconstructive surgeries. In complicated cases, we recommend referral to an experienced specialized center for definitive management.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

References

  1. Nitti VW, Tu LM, Gitlin J. Diagnosing bladder outlet obstruction in women. J Urol. 1999;161:1535.

    Article  CAS  PubMed  Google Scholar 

  2. Blaivas JG, Groutz A. Bladder outlet obstruction nomogram for women with lower urinary tract symptomatology. Neurourol Urodyn. 2000;19:553.

    Article  CAS  PubMed  Google Scholar 

  3. Blaivas JG, Santos JA, Tsui JF, Deibert CM, Rutman MP, Purohit RS, et al. Management of urethral stricture in women. J Urol. 2012;188(5):1778–82.

    Article  PubMed  Google Scholar 

  4. Bodner-Adler B, Halpern K, Hanzal E. Surgical management of urethral diverticula in women: a systematic review. Int Urogynecol J. 2016;27:993–1001.

    Article  PubMed  Google Scholar 

  5. Lee D, Zimmern P. Vaginal approach to vesicovaginal fistula. Urol Clin N Am. 2019;46:123–33.

    Article  Google Scholar 

  6. Smith AL, Ferlise VJ, Rovner ES. Female urethral strictures: successful management with long-term clean intermittent catheterization after urethral dilatation. BJU Int. 2006;98(1):96–9.

    Article  PubMed  Google Scholar 

  7. Rovner ES. Bladder and female urethral diverticula. 11th ed. Campbell-Walsh Urology; 2016. p. 2140–68.

    Google Scholar 

  8. Keegan KA, Nanigian DK, Stone AR. Female urethral stricture disease. Curr Urol Rep. 2008;9(5):419–23.

    Article  PubMed  Google Scholar 

  9. Desai S, Libertino JA, Zinman L. Primary carcinoma of the female urethra. J Urol. 1973;110(6):693–5.

    Article  CAS  PubMed  Google Scholar 

  10. Indudhara R, Vaidyanathan S, Radotra BD. Urethral tuberculosis. Urol Int. 1992;48(4):436–8.

    Article  CAS  PubMed  Google Scholar 

  11. Sarin I, Narain TA, Panwar VK, Bhadoria AS, et al. Deciphering the enigma of female urethral strictures: a systematic review and meta-analysis of management modalities. Neurourol Urodyn. 2021;40:65–79.

    Article  PubMed  Google Scholar 

  12. Huffman JW. The detailed anatomy of the paraurethral ducts in the adult human female. Am J Obstet Gynecol. 1948;55:86–101.

    Article  CAS  PubMed  Google Scholar 

  13. Wall LL. Obstetric vesicovaginal fistula as an international public-health problem. Lancet. 2006;368:1201–9.

    Article  PubMed  Google Scholar 

  14. Goodwin WE, Scardino PT. Vesicovaginal and ureterovaginal fistulas: a summary of 25 years of experience. J Urol. 1980;123:370–4.

    Article  CAS  PubMed  Google Scholar 

  15. McKay E, Watts K, Abraham N. Abdominal approach to vesicovaginal fistula. Urol Clin N Am. 2019;46:135–46.

    Article  Google Scholar 

  16. Romanzi LJ, Groutz A, Blaivas JG. Urethral diverticulum in women: diverse presentations resulting in diagnostic delay and mismanagement. J Urol. 2000;164(2):428–33.

    Article  CAS  PubMed  Google Scholar 

  17. Blaivas JG, Flisser AJ, Bleustein CB, Panagopoulos G. Periurethral masses: etiology and diagnosis in a large series of women. Obstet Gynecol. 2004;103(5 Pt 1):842–7.

    Article  PubMed  Google Scholar 

  18. Ockrim JL, Allen DJ, Shah PJ, Greenwell TJ. A tertiary experience of urethral diverticulectomy: diagnosis, imaging and surgical outcomes. BJU Int. 2009;103(11):1550–4.

    Article  PubMed  Google Scholar 

  19. Baradaran N, Chiles LR, Freilich DA, Rames RA, Cox L, Rovner ES. Female urethral diverticula in the contemporary era: is the classic triad of the “3Ds” still relevant? Urology. 2016;94:53–6.

    Article  PubMed  Google Scholar 

  20. Kuo HC. Clinical symptoms are not reliable in the diagnosis of lower urinary tract dysfunction in women. J Formos Med Assoc. 2012;111:386–91.

    Article  PubMed  Google Scholar 

  21. Agochukwu-Mmonu N, Srirangapatnam S, Cohen A, Breyer B. Female urethral strictures: review of diagnosis, etiology, and management. Curr Urol Rep. 2019;20(11):74.

    Article  PubMed  Google Scholar 

  22. Kalra S, Gupta P, Dorairajan L, Hota S, et al. Does successful urethral calibration rule out significant female urethral stenosis? Confronting the confounder- an outcome analysis of successfully treated female urethral strictures. Int Braz J Urol. 2021;47:829–40.

    Article  PubMed  PubMed Central  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  24. Itani M, Kielar A, Menias CO, Dighe MK, Surabhi V, Prasad SR, O’Malley R, Gangadhar K, Lalwani N. MRI of female urethra and periurethral pathologies. Int Urogynecol J. 2016;27(2):195–204.

    Article  PubMed  Google Scholar 

  25. Crescenze IM, Goldman HB. Female urethral diverticulum: current diagnosis and management. Curr Urol Rep. 2015;16(10):71.

    Article  PubMed  Google Scholar 

  26. Mistry MA, Klarskov N, DeLancey JO, Lose G. A structured review on the female urethral anatomy and innervation with an emphasis on the role of the urethral longitudinal smooth muscle. Int Urogynecol J. 2020;31(1):63–71.

    Article  PubMed  Google Scholar 

  27. Pincus JB, Laudano M, Leegant A, Downing K. Female urethral diverticula: diagnosis, pathology, and surgical outcomes at an academic, urban medical Center. Urology. 2019;128:42–6.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  29. Mozafarpour S, Nwaoha N, Pucheril D, De EJB. Robotic assisted proximal dorsal urethral diverticulectomy. Int Urogynecol J. 2021;32(10):2863–6.

    Article  PubMed  Google Scholar 

  30. Juang CM, Horng HC, Yu HC, Chen CY, Chang CM, Yu KJ, Yen MS. Combined diverticulectomy and anti-incontinence surgery for patients with urethral diverticulum and stress urinary incontinence: is anti-incontinence surgery really necessary? Taiwan J Obstet Gynecol. 2006;45(1):67–9.

    Article  PubMed  Google Scholar 

  31. Reeves FA, Inman RD, Chapple CR. Management of symptomatic urethral diverticula in women: a single-center experience. Eur Urol. 2014;66(1):164–72.

    Article  PubMed  Google Scholar 

  32. Heidari F, Abbaszadeh S, Ghadian A, Tehrani KF. On demand urethral dilatation versus intermittent urethral dilatation: results and complications in women with urethral stricture. Nephrourol Mon. 2014;6(2):e15212.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Önol FF, Antar B, Köse O, Erdem MR, Önol ŞY. Techniques and results of urethroplasty for female urethral strictures: our experience with 17 patients. Urology. 2011;77(6):1318–24.

    Article  PubMed  Google Scholar 

  34. Romero-Maroto J, Verdú-Verdú L, Gómez-Pérez L, Pérez-Tomás C, Pacheco-Bru JJ, López-López A. Lateral-based anterior vaginal wall flap in the treatment of female urethral stricture: efficacy and safety. Eur Urol. 2018;73(1):123–8.

    Article  PubMed  Google Scholar 

  35. Sharma GK, Pandey A, Bansal H, et al. Dorsal onlay lingual mucosal graft urethroplasty for urethral strictures in women. BJU Int. 2010;105(9):1309–12.

    Article  PubMed  Google Scholar 

  36. Stamatakos M, Sargedi C, Stasinou T, Kontzoglou K. Vesicovaginal fistula: diagnosis and management. Indian J Surg. 2014;76:131–6.

    Article  PubMed  Google Scholar 

  37. Fouad LS, Chen AH, Santoni CJ, Wehbe C, Pettit PD. Revisiting conservative management of vesicovaginal fistula. J Minim Invasive Gynecol. 2017;24(4):514–5.

    Article  PubMed  Google Scholar 

  38. Malik MA, Sohail M, Malik MT, Khalid N, Akram A. Changing trends in the etiology and management of vesicovaginal fistula. Int J Urol. 2018;25(1):25–9.

    Article  PubMed  Google Scholar 

  39. Lin KJ, Fan YH, Lin AT. Role of urodynamics in management of urethral diverticulum in females. J Chin Med Assoc. 2017;80(11):712–6.

    Article  PubMed  Google Scholar 

  40. Waterloos M, Verla W. Female urethroplasty: a practical guide emphasizing diagnosis and surgical treatment of female urethral stricture disease. Biomed Res Int. 2019;2019:6715257.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Nickles SW, Ikwuezunma G, MacLachlan L, El-Zawahry A, Rames R, Rovner E. Simple vs complex urethral diverticulum: presentation and outcomes. Urology. 2014;84(6):1516–9.

    Article  PubMed  Google Scholar 

  42. Ko KJ, Suh YS, Kim TH, Lee HS, Cho WJ, Han DH, Lee KS. Surgical outcomes of primary and recurrent female urethral diverticula. Urology. 2017;105:181–5.

    Article  PubMed  Google Scholar 

  43. Osman NI, Mangera A, Chapple CR. A systematic review of surgical techniques used in the treatment of female urethral stricture. Eur Urol. 2013;64(6):965–73.

    Article  PubMed  Google Scholar 

  44. Romman AN, Alhalabi F, Zimmern PE. Distal intramural urethral pathology in women. J Urol. 2012;188:1218–23.

    Article  PubMed  Google Scholar 

  45. Popat S, Zimmern PE. Long-term management of luminal urethral stricture in women. Int Urogynecol J. 2016;27(11):1735–41.

    Article  PubMed  Google Scholar 

  46. Kowalik C, Stoffel JT, Zinman L, Vanni AJ, Buckley JC. Intermediate outcomes after female urethral reconstruction: graft vs flap. Urology. 2014;83(5):1181–5.

    Article  PubMed  Google Scholar 

  47. Blandy JP, Badenoch DF, Fowler CG, Jenkins BJ, Thomas NW. Early repair of iatrogenic injury to the ureter or bladder after gynecological surgery. J Urol. 1991;146(3):761–5.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Alvarez de Toledo, I. (2023). Female Urethral Reconstruction. In: Martins, F.E., Holm, H.V., Sandhu, J., McCammon, K.A. (eds) Female Genitourinary and Pelvic Floor Reconstruction. Springer, Cham. https://doi.org/10.1007/978-3-030-71112-2_48-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-71112-2_48-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-71112-2

  • Online ISBN: 978-3-030-71112-2

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics