Long-Term Management of Luminal Urethral Stricture in Women

BACKGROUND: Luminal urethral strictures (LUS), though rare, are very bothersome conditions that can cause significant voiding symptoms and adversely affect women's' quality of life. Urethral dilation (UD) is commonly employed to address LUS. While UD in the office has been popular, the data regarding UD under general anesthesia is limited. Current literature on this subject is very limited, with small sample sizes and short follow-up. OBJECTIVE: To report our long-term experience of LUS in women treated with dilation under general anesthesia. METHODS: Following IRB approval, charts of women who underwent UD under general anesthesia for LUS and had over 6 months follow-up were reviewed. LUS was confirmed by urethroscopy. UD was performed with female dilators and with guidewire and Heyman dilators when required. Outcome measures included number of UD procedures and duration and frequency of clean intermittent catheterization (CIC). Success was defined as ability to void without repeat UD and with no need for CIC 1 year after UD. Possible predictive variables were analyzed. RESULTS: Between 2000 and 2013, 30 of 32 women who underwent UD for LUS met inclusion criteria. Mean follow-up was 59 (range: 7 to 151) months. Thirteen women in the success group had improvement in mean maximum flow rate (pre: 11 ml/sec to post: 27.8 ml/sec) and post-void residual (pre: 85 ml to post: 43 ml). In the failure group of 17 patients, 2 required chronic CIC 1 year after a single UD. Fifteen opted for repeat UD. After second (n=5), third (n=2), and fourth (n=2) UD, 9 patients came off CIC and reported durable satisfaction. Four women remained on CIC regularly. Two required permanent suprapubic catheter. CONCLUSION: At a mean follow-up of 5 years, UD for LUS produced durable resolution in 43% of our patients. Another 30% fully benefited from repeat UDs. Shorter duration of symptoms prior to presentation was significantly associated with success.