Challenges in management of female urethral strictures utilizing postmenopausal vaginal graft: A case report

Abstract

Introduction

Female urethral strictures are a rare occurrence and patients usually present with lower urinary tract symptoms. This non-specific presentation and rare occurrence pose a challenge to clinicians regarding timely diagnosis and intervention.

Case presentation

A 54-year-old para 3 + 0 postmenopausal patient presented to the clinic with complaints of voiding difficulty, suprapubic pain, a weak urinary stream, dribbling, straining and a sensation of incomplete bladder emptying. She had been previously managed twice for similar symptoms with urethral dilatation. Intermittent catheterization was utilized on the second episode with improvement of her symptoms.

During this third episode, micturating cystourethrogram demonstrated a urethral stricture and uroflowmetry revealed a reduced Qmax.

She underwent a dorsal urethroplasty with no intraoperative complications. Her recovery post procedure was unremarkable with resolution of her symptoms and an improvement of her Qmax on repeat uroflowmetry.

Conclusion

Urethroplasty is a viable and definitive management option for female urethral strictures. Timely diagnosis of urethral strictures requires a high index of suspicion and appropriate investigations. Post-menopausal atrophic vaginal mucosa offers a suitable alternative for graft harvesting.