Vestibular flap urethroplasty in women with recurrent distal intramural urethral pathology

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.