Vaginal and Labial Graft Urethroplasty in Female Urethral Stricture: A Systematic Review
DOI:
https://doi.org/10.37287/ijghr.v8i3.1488Keywords:
female urethral stricture, labial graft urethroplasty, vaginal wall graft urethroplastyAbstract
Female urethral stricture is considered a relatively uncommon clinical condition, and urethral dilatation has traditionally been the preferred treatment. In recent years, various reconstructive surgical techniques have emerged to provide more definitive management for this challenging group of patients, including the use of grafts in urethroplasty. This study aimed to review the use of vaginal and labial grafts in urethroplasty for female urethral stricture. A systematic review was conducted using PubMed and related databases to identify studies published between 2014 and April 2025. The results were classified according to surgical technique and type of graft used in augmentation urethroplasty. A total of seven studies involving 119 patients were included. The mean follow-up period was 13.55 months for labial grafts and 17.23 months for vaginal wall grafts. Labial grafts demonstrated slightly higher success rates (84%) compared to vaginal grafts (81.73%). In the vaginal graft group, incontinence and recurrence were reported in 17.5% of cases, while failed calibration occurred in 3.8% of patients in the labial graft group. No major donor-site complications were reported. Overall, both graft types provide feasible and safe options for managing female urethral stricture, with labial grafts showing slightly better outcomes.
References
Agochukwu-Mmonu, N., Srirangapatanam, S., Cohen, A., & Breyer, B. (2019). Female urethral strictures: Review of diagnosis, etiology, and management. Current Urology Reports, 20(11). https://doi.org/10.1007/s11934-019-0933-1
Al-misbah, T., Chowdhury, A. T. M. M., Bashar, A., Ahmed, S., & Enayetullah, I. (2023). Labial mucosal substitution urethroplasty for female urethral stricture: A sustainable technique. Bangladesh Journal of Urology, 26(591), 78–83.
Bain, M., et al. (2025). Female urethral stricture: A multi-centre experience and lessons learnt. BJUI Compass, 6(5), 1–7. https://doi.org/10.1002/bco2.70024
Campbell, J., Vanni, A. J., & Kowalik, C. G. (2022). An update on female urethral stricture disease. Current Urology Reports, 23(11), 303–308. https://doi.org/10.1007/s11934-022-01113-w
Carr, L. K., & Webster, G. D. (1996). Bladder outlet obstruction in women. Urologic Clinics of North America, 23(3), 385–392. https://doi.org/10.1016/S0094-0143(05)70319-0
Chua, K. J., et al. (2021). Treatment of urethral stricture disease in women: Nonsystematic review of surgical techniques and intraoperative considerations. Research and Reports in Urology, 13, 381–406. https://doi.org/10.2147/RRU.S282651
Faiena, I., Koprowski, C., & Tunuguntla, H. (2016). Female urethral reconstruction. The Journal of Urology, 195(3), 557–567. https://doi.org/10.1016/j.juro.2015.07.124
Groutz, A., Blaivas, J. G., & Chaikin, D. C. (2000). Bladder outlet obstruction in women: Definition and characteristics. Neurourology and Urodynamics, 19(3), 213–220. https://doi.org/10.1002/(SICI)1520-6777(2000)19:3<213::AID-NAU2>3.0.CO;2-U
Gundogdu, G., et al. (2023). Development of male and female models of long urethral strictures in swine. Surgical Open Science, 16, 205–214. https://doi.org/10.1016/j.sopen.2023.11.002
Hadidi, A. T. (2013). Functional urethral obstruction following tubularised incised plate repair of hypospadias. Journal of Pediatric Surgery, 48(8), 1778–1783. https://doi.org/10.1016/j.jpedsurg.2012.10.071
Hampson, L. A., et al. (2019). Dorsal buccal graft urethroplasty in female urethral stricture disease: A multi-center experience. Translational Andrology and Urology, 8(Suppl 1), S6–S12. https://doi.org/10.21037/tau.2019.03.02
Hoag, N., & Chee, J. (2017). Surgical management of female urethral strictures. Translational Andrology and Urology, 6(Suppl 2), S76–S80. https://doi.org/10.21037/tau.2017.01.20
Hoag, N., Gani, J., & Chee, J. (2016). Vaginal-sparing ventral buccal mucosal graft urethroplasty for female urethral stricture: A novel modification of surgical technique. Investigative and Clinical Urology, 57(4), 298–302. https://doi.org/10.4111/icu.2016.57.4.298
Hussain, S., Solanki, F. S., Sharma, D. B., Agarwal, P., & Sharma, D. (2024). Substitution urethroplasty in female urethral stricture—Our initial experience. Indian Journal of Surgery, 86(6), 1201–1206. https://doi.org/10.1007/s12262-024-04036-7
Kaushal, D., Vashishtha, S., Ali, A., Agarwal, M., & Professor, A. (2018). Dorsal onlay vaginal mucosal graft urethroplasty for refractory female urethral stricture. International Journal of Medical and Health Research, 4(5), 51–55.
Kore, R. N., & Martins, F. E. (2022). Dorsal onlay urethroplasty using buccal mucosal graft and vaginal wall graft for female urethral stricture: Outcome of two-institution study. Indian Journal of Urology, 38(2), 140–145. https://doi.org/10.4103/iju.iju_329_21
Kuo, H. C. (2005). Videourodynamic characteristics and lower urinary tract symptoms of female bladder outlet obstruction. Urology, 66(5), 1005–1009. https://doi.org/10.1016/j.urology.2005.05.047
Lumen, N., et al. (2021). European Association of Urology guidelines on urethral stricture disease (Part 1): Management of male urethral stricture disease. European Urology, 80(2), 190–200. https://doi.org/10.1016/j.eururo.2021.05.022
Lumen, N., et al. (2024). EAU pocket guidelines on urethral strictures. European Association of Urology.
Manasa, T., Khattar, N., Tripathi, M., Varshney, A., Goel, H., & Sood, R. (2019). Dorsal onlay graft urethroplasty for female urethral stricture improves sexual function: Short-term results of a prospective study using vaginal graft. Indian Journal of Urology, 35(4), 267–272. https://doi.org/10.4103/iju.IJU-134-19
Massey, J. A., & Abrams, P. H. (1988). Obstructed voiding in the female. British Journal of Urology, 61(1), 36–39. https://doi.org/10.1111/j.1464-410X.1988.tb09158.x
Osman, N. I., Mangera, A., & Chapple, C. R. (2013). A systematic review of surgical techniques used in the treatment of female urethral stricture. European Urology, 64(6), 965–973. https://doi.org/10.1016/j.eururo.2013.07.038
Önol, F. F., Önol, Ş. Y., Tahra, A., & Boylu, U. (2014). Ventral inlay labia minora graft urethroplasty for the management of female urethral strictures. Urology, 83(2), 460–464. https://doi.org/10.1016/j.urology.2013.09.020
Önol, F. F., Antar, B., Köse, O., Erdem, M. R., & Önol, Ş. Y. (2011). Techniques and results of urethroplasty for female urethral strictures. Urology, 77(6), 1318–1324. https://doi.org/10.1016/j.urology.2011.01.017
Petrou, S. P., Rogers, A. E., Parker, A. S., Green, K. M., & McRoberts, J. W. (2012). Dorsal vaginal graft urethroplasty for female urethral stricture disease. BJU International, 110(11C), 2–7. https://doi.org/10.1111/j.1464-410X.2012.11233.x
Rehder, P., et al. (2010). Dorsal urethroplasty with labia minora skin graft for female urethral strictures. BJU International, 106(8), 1211–1214. https://doi.org/10.1111/j.1464-410X.2010.09240.x
Sahin, C., & Yesildal, C. (2022). Female urethral stricture: Which one is stronger? Labial vs buccal graft. International Urogynecology Journal, 33(3), 731–735. https://doi.org/10.1007/s00192-021-05052-x
Sarin, I., et al. (2021). Deciphering the enigma of female urethral strictures: A systematic review and meta-analysis. Neurourology and Urodynamics, 40(1), 65–79. https://doi.org/10.1002/nau.24584
Singh, M., et al. (2013). Dorsal onlay vaginal graft urethroplasty for female urethral stricture. Indian Journal of Urology, 29(2), 124–128. https://doi.org/10.4103/0970-1591.114034
Smith, A. L., Ferlise, V. J., & Rovner, E. S. (2006). Female urethral strictures: Successful management with long-term clean intermittent catheterization after urethral dilatation. BJU International, 98(1), 96–99. https://doi.org/10.1111/j.1464-410X.2006.06206.x
Spilotros, M., et al. (2017). Female urethral stricture: A contemporary series. World Journal of Urology, 35(6), 991–995. https://doi.org/10.1007/s00345-016-1947-7
Tanello, M., et al. (2002). Use of pedicle flap from the labia minora for the repair of female urethral strictures. Urologia Internationalis, 69(2), 95–98. https://doi.org/10.1159/000065554
Tsivian, A., & Sidi, A. A. (2006). Dorsal graft urethroplasty for female urethral stricture. The Journal of Urology, 176(2), 611–613. https://doi.org/10.1016/j.juro.2006.03.055
West, C., & Lawrence, A. (2019). Female urethroplasty: Contemporary thinking. World Journal of Urology, 37(4), 619–629. https://doi.org/10.1007/s00345-018-2564-4
Waterloos, M., et al. (2021). Female urethroplasty: Outcomes of different techniques in a single center. Journal of Clinical Medicine, 10(17). https://doi.org/10.3390/jcm10173950
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