Background:
Stricture disease in females is an uncommon problem often treated with repeated urethral dilations or internal urethrotomy. The sequelae of inadequately treated stricture disease include recurrent urinary tract infections, symptoms of urgency and frequency, and rarely uremia. In the literature there are few methods described to surgically repair female stricture disease. Although these repairs demonstrate satisfactory results and support the use of primary surgical repair they are somewhat complicated and cumbersome to use. McGuire, in his textbook of Female Urology, described the method first used by Blandy as a simple and easy to learn technique. This is the first report of its use and clinical results in a series of patients from 2 institutions.
Methods:
Eight women were diagnosed with symptomatic stricture based on a history of traumatic or difficult catheterization, a history of at least one urethral dilation or urethrotomy, and difficult or failed attempt at catheter placement. Four patients had recurrent urinary tract infections, the average post void residual (PVR) was 130 cc, and the average caliber of the urethra was 9.5 Fr. One patient presented with an elevation of her creatinine and bilateral hydronephrosis. Two patients had urodynamics which confirmed stress incontinence and had a simultaneous pubo-vaginal sling. After incision of the urethral stricture posteriorly a V shaped flap of vaginal tissue is advanced into the defect and sutured into place. A 22 Fr. cystoscope is passed at the end of the procedure. Following removal of the foley patients were started on daily clean intermittent catheterization with a 14 Fr. catheter. A retrospective chart review was performed.
Results:
Follow up ranged from one to nine years. All patients had subjective relief of their symptoms as assessed by history and could easily catheterize with a 14 Fr. catheter. The average caliber of the urethra increased to 16.5 and the PVR decreased to 15 cc. The four patients with recurrent infections had resolution of these infections. One patient with a hypotonic bladder had retention which resolved in 3 months. One patient was re-dilated once 3 weeks after the primary procedure with no recurrence. No patients developed stress urinary incontinence. There were no immediate or delayed serious complications.
Conclusions:
Urethral stricture disease in females is an uncommon entity that can cause voiding symptoms, recurrent infections, retention, and renal impairment. This method of surgical repair offers a durable result and has a low incidence of complications.

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