Female urethral strictures: successful management with long-term clean intermittent catheterization after urethral dilatation.
OBJECTIVE
To report our experience in the diagnosis and treatment of urethral stricture in women.


METHODS
A retrospective review of records and video-urodynamics identified women treated for urethral stricture between 1999 and 2004 at one institution by one surgeon. Urethral stricture was defined as a fixed anatomical narrowing between the bladder neck and distal urethra of <14 F preventing catheterization, and the diagnosis was confirmed by cysto-urethroscopy, and/or video-urodynamics. Women with a history of external beam radiotherapy to the pelvis, or of gynaecological, urethral or bladder malignancy, were excluded, and the women had a urethral biopsy to exclude a malignant cause of the stricture. Initial treatment consisted of urethral dilatation to > or = 30 F. After a period of indwelling catheterization, the women were placed on clean intermittent self-catheterization (CISC) at least once daily, and monitored every 3-6 months. At each follow-up, the urethra was catheterized to exclude recurrence. American Urological Association (AUA) symptom scores were obtained at presentation and at the initial 3 month follow-up.


RESULTS
Seven women met the criteria for urethral stricture, and were followed for a mean (range) of 21 (6-34) months. All were initially maintained on daily CISC, and some were gradually reduced to weekly CISC for the duration of follow-up. No patient had a recurrent stricture while on CISC, and none has had a urethral reconstruction to manage their condition. AUA symptom scores improved in all of the women by a mean of 10.7 points. No complications related to catheterization were noted.


CONCLUSIONS
Urethral stricture is rare in women. Long-term CISC in these women is safe and effective, and can avoid the need for major reconstructive surgery.
Smith
Ariana L
AL
Division of Urology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Ferlise
Victor J
VJ
Rovner
Eric S
ES
D000328:Adult; D000368:Aged; D002408:Catheters, Indwelling; D004106:Dilatation; D005260:Female; D006801:Humans; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D012648:Self Care; D016896:Treatment Outcome; D014525:Urethral Stricture / Q000601:surgery*; D014546:Urinary Catheterization / Q000379:methods*