(162) Outcomes of Reconstructive Surgery for Female Urethral Disease: A Single-Center Experience

Introduction Female lower urinary tract symptoms (LUTS) are often multifactorial, but structural etiologies such as urethral stricture (FUS), urethral diverticulum (FUD), and periurethral masses represent under-recognized causes of bladder outlet obstruction (BOO). Diagnostic criteria and standardized surgical strategies remain limited, and fear of postoperative incontinence may discourage reconstructive approaches. Objective To evaluate outcomes and patient-reported results after reconstructive surgery for FUS, FUD, and periurethral masses, providing practical insights into technique selection. Methods A retrospective analysis was conducted on a prospectively maintained database of women who underwent urethral surgery between January 2017 and April 2024. Standardized preoperative work-up included physical and urogynaecological examination, uroflowmetry, post-void residual, urinalysis, and magnetic resonance imaging (MRI) or urethrocystoscopy when indicated. Surgical procedures comprised dorsal inlay buccal mucosa graft (DMG), ventral onlay grafts (VOG; buccal or vaginal), partial diverticulectomy with fascial reconstruction, and periurethral mass excision with selective fascial reinforcement. Outcomes included perioperative complications, reintervention, and changes in LUTS assessed with a modified International Consultation on Incontinence Questionnaire–Female LUTS (ICIQ-FLUTS) Long Form, analyzed with Wilcoxon tests (p<0.05). Results Overall, 116 women (mean age 50.6±13.8 years) were included: ventral urethroplasty (n=62), dorsal urethroplasty (n=13), FUD surgery (n=31), and periurethral mass excision (n=10). Ventral urethroplasties predominantly used buccal grafts (88.7%), while all dorsal repairs were DMG. Complication rates were low after ventral (4.8%) and dorsal (7.7%) urethroplasty, minimal in periurethral mass excision (10%), and higher after FUD (32.2%), mainly self-limiting pain. Persistent mild stress urinary incontinence occurred in two FUD cases. Median follow-up was 32 months (IQR 18–63). Significant improvement was observed in storage, voiding, post-micturition, and pain/burning domains across all groups; incontinence improved after ventral urethroplasty and FUD procedures. Conclusions Female urethral reconstructive surgery is safe and effective when performed with precise anatomical respect. Technique selection that preserves sphincteric function and periurethral support-through selective grafting and limited dissection-optimizes continence and minimizes complications. These results support reconstructive approaches as the gold standard for symptomatic female urethral disease in experienced hands. Disclosure No