Female urethral stricture: techniques for reconstruction

Female urethral stricture (FUS) is a rare condition. It was not studied robustly for many years, but interest has grown recently in the reconstructive urology community, leading to an increase in publications. In this review, we gather the latest data regarding FUS and its different therapeutic options. Studies are summarized, split by technique. We also review the recently published European Guidelines. In addition, we share our preferred surgical technique and our views on future options. Diagnosing FUS can often be challenging and requires a high index of clinical suspicion. Its vague clinical symptoms and empiric initial treatments combine to make FUS an underdiagnosed condition. The lack of consensus on how to define FUS also compounds the problem. Appropriate diagnosis requires thorough investigation, and ancillary studies such as video urodynamics, cystoscopy, and voiding cystourethrogram may be useful. Treatment options range from conservative management to definitive procedures, although studies have shown that conservative measures such as urethral dilation have a low success rate overall. Within definitive management, augmented urethroplasty - using either flaps or grafts, has proven to be the gold standard. Both have shown excellent results over time; however, there is insufficient data available to recommend one over the other. Contemporary data has an overall poor level of evidence. Although challenging due to the rarity of the problem, a proper randomized controlled clinical trial comparing the principal surgical options and their outcomes would be beneficial and would allow for more informed decision making when considering options for women with urethral stricture.

Peculiarities of Sexual Health of Women of Reproductive Age Depending on the Types of Localization of Paraurethral Glands

Sexual health is a state of physical, emotional, mental and social well-being associated with sexuality. The complexity of the female sexual reaction lies in its dependence on many physiological, psychological and sociocultural factors. The objective: a comprehensive analysis of erogenous zones in women of reproductive age, taking into account the types of localization of the paraurethral glands, assessment of their sexual function and the causes of its disorders. Materials and methods. A comprehensive study to confirm the existence of female paraurethral glands and their functional activity, performed at the Institute of Urology of the National Academy of Medical Sciences of Ukraine (Department of Reconstructive Urology and Advanced Technologies), took 94 relatively healthy women of reproductive age, who as a result of a comprehensive examination paraurethral glands of different types of localization (anterior, posterior, diffuse). Analytical-synthetic, comparative analyzes were used. Average values with their standard error were calculated; in cases of comparison of statistical values, Student’s test was used. Results. The relationship between the localization of the paraurethral glands in women of reproductive age and the peculiarity of the manifestation of sexual relations has been traced. Differences in the number and severity of the reaction of erogenous zones among this category were revealed. Sexual dysfunctions in 24 (25.5%) of 94 women were predominantly in the posterior type of localization of the glands (50% versus 37.5% and 12.5% in the anterior and diffuse types, respectively). Among the reasons for dissatisfaction with sexual relations, women most often indicated satisfaction (36.2%), then – reaching orgasm (22.4%) every fifth noted the absence (decrease) of sexual arousal and 13.7% – a decrease in desire; dyspareunia was observed in 8.6% of cases, was inconsistent and manifested itself with individual partners. These features were mostly manifested in cases with the posterior type of localization of the paraurethral glands of different reproductive ages. Conclusion. The results obtained made it possible to reveal the features of the sexual life in women, depending on the type of localization of their paraurethral glands.

Application of the cell-free matrix of the donor artery for plasty of posterior urethral strictures

Introduction. Urethral stricture is a complex and urgent problem in operative urology. The main problem in the treatment of extended structures of the posterior urethra is the inability to form an adequate urethral site for augmentation urethroplasty with the common buccal graft, which has a priority in the treatment of penile strictures. The use of tissue acellular matrices may be promising in the development of reconstructive urology, which in the future will solve a number of problems associated with augmentation urethroplasty. The purpose of this article is to study the possibility of using a cell-free matrix of a donor artery as a free flat flap for stricture replacement urethroplasty on a model of laboratory animals (rabbits). Materials and methods. Donor blood vessels were Used, which were subjected to detergent-enzymatic perfusion decellularization. To assess the quality of the cell-free matrix, a histological study and an immunohistochemical study were performed. The cell-free flap of the donor artery was fixed to the protein envelope from the side of the simulated defect and posterior on-lay urethroplasty was performed.Results and discussion. The resulting matrix was characterized by the absence of detectable cell nuclei, preserved type I collagen, and a DNA content of no more than 50 ng / mg of tissue. In the postoperative period, normal motor activity of animals, normal urination, weight loss was not observed. The levels of C- reactive protein, creatinine, and urea in peripheral blood 5 months after surgery were within the normal range: 0.285±0.04839 mg / l, 93.5±8.057 mm / l, and 8.35±1.355 mm/l, respectively. If cystourethrography with the help of computer tomography data for stricture of the urethra is not revealed. During magnetic resonance imaging in the axial and sagittal projections, the patency of the urethra was indirectly confirmed. Conclusion. In a laboratory animal model, it was shown that the resulting cell-free flap has in vivo biocompatibility and can be used for replacement urethroplasty of posterior urethral strictures.