Treatment of Urethral Strictures in Women

The limited coverage of female infravesical obstruction has led to the absence of a clear algorithm for the diagnosis and treatment of urethral strictures in women. Currently, various treatment methods are used—from urethral dilation to urethroplasty—with their effectiveness and indications remaining the subject of ongoing discussion. The article discusses the issues of etiology, diagnosis, and treatment of urethral strictures in women and examines the effectiveness of various invasive methods for managing narrowing of the female urethra. The required information was searched in PubMed, Web of Science, CyberLeninka, eLibrary, and Scopus databases for the period 1999–2022 using the following keywords: стеноз меатуса (meatal stenosis), стриктура уретры у женщин (female urethral stricture), стриктурная болезнь уретры (urethral stricture disease), вентральная уретропластика слизистой половой губы и влагалища (ventral urethroplasty using labial and vaginal mucosa), дорсальная буккальная уретропластика (dorsal buccal urethroplasty), пластика уретры лоскутом стенки влагалища (urethral reconstruction using vaginal wall flap), бужирование (urethral dilation), обструктивное мочеиспускание у женщин (female obstructive voiding), and инфравезикальная обструкция у женщин (female infravesical obstruction). It was noted that urethral dilation and internal optical urethrotomy are often used as initial treatments and demonstrate satisfactory results, though they are associated with a relatively high recurrence rate. In patients with partial urethral obliteration and recurrent stricture after previous interventions, subsequent surgical options may include urethral reconstruction using flaps of the anterior or lateral vaginal wall, vestibular flaps, or free grafts (in dorsal or ventral position). The choice of surgical technique may be influenced by several factors—location and length of the stricture, presence of trophic changes in the mucosa, mechanism of development, as well as the surgeon’s experience and preferences. Urethrotomy and dilation may be used as initial treatment methods in some cases; however, in the presence of recurrence, marked fibrotic changes, and significant stenosis, urethroplasty is considered more appropriate. Flap-based urethroplasty techniques have demonstrated effectiveness and safety and may therefore represent a preferred treatment method for female urethral strictures.