Long-term functional success and patient-reported outcomes after female one-stage buccal mucosal graft urethroplasty

J Klemm; P Marks; R J Schulz; D K Filipas; D R Stelzl; R Dahlem; M Fisch; M W Vetterlein; Trauma and Reconstructive Urology Working Party of the European Association of Urology Young Academic Urologists

doi:10.1016/j.acuroe.2024.05.014

Long-term functional success and patient-reported outcomes after female one-stage buccal mucosal graft urethroplasty

Actas Urol Esp (Engl Ed). 2024 May 14:S2173-5786(24)00074-X. doi: 10.1016/j.acuroe.2024.05.014. Online ahead of print.

[Article in English, Spanish]

Authors

J Klemm¹, P Marks¹, R J Schulz¹, D K Filipas¹, D R Stelzl¹, R Dahlem¹, M Fisch¹, M W Vetterlein²; Trauma and Reconstructive Urology Working Party of the European Association of Urology Young Academic Urologists¹

Affiliations

¹ Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
² Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: m.vetterlein@uke.de.

PMID: 38754730
DOI: 10.1016/j.acuroe.2024.05.014

Abstract

Introduction and objectives: Female urethral strictures are a rare condition that significantly impacts patients' quality of life. Patient-reported outcomes are crucial, yet data regarding sexual function and treatment satisfaction are scarce. We aimed to provide insights from a reconstructive referral center.

Patients and methods: We conducted a retrospective analysis of women treated with ventral onlay one-stage buccal mucosa graft urethroplasty for urethral strictures between 2009-2023. We assessed objective (retreatment-free survival, ΔQmax) and subjective outcomes (validated patient-reported outcomes).

Results: Of 12 women, 83% and 17% had iatrogenic and idiopathic strictures, respectively. Median number of prior interventions was 6. Strictures were located meatal and mid-urethral in 25% and 75%, respectively, 22% had the bladder neck involved. Median graft length was 2 cm. At median follow-up of 66 months, 33% of patients underwent stricture retreatment, but only one case occurred within the first 2 years postoperatively. The median improvement in maximum flow rate (ΔQmax) was 10 ml/s. Median International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Modules (ICIQ-FLUTS) scores were 8 for filling symptoms, 6 for voiding symptoms, and 3 for incontinence symptoms. Median ICIQ-FLUTSsex score was 4. Higher scores indicate a higher symptom burden. Median ICIQ-Satisfaction outcome and satisfaction scores were 18 and 7, respectively, reflecting high treatment satisfaction.

Conclusions: Buccal mucosal graft urethroplasty by ventral onlay for female urethral strictures yields effective, durable, and positively received outcomes. However, larger studies across multiple institutions are necessary to further assess its efficacy, especially regarding patient-reported experiences and sexual function.

Keywords: Enfermedades urogenitales en la mujer; Estenosis uretral; Female urogenital diseases; Lower urinary tract symptoms; Patient reported outcome measures; Resultados comunicados por el paciente; Salud sexual; Sexual health; Síntomas del tracto urinario inferior; Urethral stricture.