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Deciphering the enigma of female urethral strictures: A systematic review and meta‐analysis of management modalities
Author(s) -
Sarin Indira,
Narain Tushar A.,
Panwar Vikas K.,
Bhadoria Ajeet S.,
Goldman Howard B.,
Mittal Ankur
Publication year - 2021
Publication title -
neurourology and urodynamics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 90
eISSN - 1520-6777
pISSN - 0733-2467
DOI - 10.1002/nau.24584
Subject(s) - urethroplasty , medicine , meta analysis , systematic review , urethral stricture , surgery , medline , randomized controlled trial , urethra , political science , law
Objective To evaluate the management methods of female urethral stricture (FUS) and analyze the outcomes of surgical treatments. A meta‐analysis was done in an attempt to identify the best approach of urethroplasty and the graft‐of‐choice. Materials and Methods A systematic search of Pubmed/Medline and Embase databases was performed according to the Preferred Reporting Items For Systematic Review And Meta‐Analysis statement, for articles reporting on FUS management in the last decade. The Newcastle‐Ottawa scale was used to assess the quality of 28 included non‐randomized studies. The data on FUS management was summarized and pooled success rates (taken as symptom improvement and no need for further instrumentation) were compared. The secondary outcome was to establish a diagnostic modality of choice and define a “successful‐outcome” of repair. Results The outcome was separately reported for 554 women undergoing surgical intervention for FUS in the literature. The criteria defining FUS were varied. A combination of tests was used for diagnosis as none was singularly conclusive. A total of 301 patients had previous urethral instrumentations. The pooled success rate of urethral dilatation (234 women) was 49% at a mean follow‐up of 32 months; flap urethroplasty (108 cases) was 92% at a mean follow‐up of 42 months; buccal mucosal graft (BMG) urethroplasty (133 cases) was 89% at a mean follow‐up of 19 months; vaginal graft augmentation (44 cases) was 87% at a mean follow‐up of 15 months; and labial graft reconstruction (19 cases) was 89% at a mean follow‐up of 18.4 months. The dorsal approach of graft augmentation met with 88% (95% confidence interval [CI] 0.79–0.95) success compared with 95% (95% CI 0.86–1) for the ventral approach. Conclusion FUS is a rare condition requiring a meticulous diagnostic workup using multiple tests. All urethroplasties have shown better pooled success rates (86%–93%) compared with dilatation (49%). BMG is equally effective as vaginal graft urethroplasty.