title: A rationale for procedure selection to repair female urethral stricture associated with urethrovaginal fistulas.
abstract: OBJECTIVE
  We investigated a rationale for procedure selection to repair female urethral stricture associated with urethrovaginal fistula. We compared the outcomes of the 5 techniques used.
  
  
  METHODS
  Between January 1999 and October 2011, 44 female patients with urethral stricture associated with urethrovaginal fistula were treated using a total of 5 techniques. The surgical techniques were labial pedicle flap urethroplasty in 24 patients, vulvar flap urethroplasty in 3, anterior vaginal flap urethroplasty in 11, end-to-end anastomosis in 4 and bladder flap urethroplasty in 2. Supplementary procedures were performed in some patients during urethroplasty, including bladder neck reshaping for incontinence in 5, intestinal-vaginal fistula repair in 3, colpoplasty for island vulvar skin flaps in 3, middle vaginal stricture vaginoplasty in 2 and enlargement of the vaginal introitus in 1.
  
  
  RESULTS
  Average postoperative followup was 42.3 months (range 6 to 140). Urethrovaginal fistula recurred in 2 patients because of infection, urethral stricture developed in 1 and stress incontinence appeared in 1. The other patients voided normally with an average maximum urine flow greater than 15 ml per second (range 16.7 to 46). The overall anatomical success rate was 93.18% (41 of 44 cases) and the functional success rate was 90.91% (40 of 44).
  
  
  CONCLUSIONS
  Surgical procedures for treating female urethral strictures with urethrovaginal fistulas should be based on fistula location, stricture length and vaginal anatomy. A transvaginal approach might be optimal if the vagina is wide and easily dilated. Pedicle labial flap urethroplasty was a reliable technique for complex strictures.
authors.affiliation: Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiaotong University and Shanghai Eastern Institute for Urologic Repair and Reconstruction, Shanghai, People's Republic of China. xuyuemin@263.net
authors.forename: Yue-Min
authors.initials: YM
authors.lastname: Xu
authors.forename: Ying-Long
authors.initials: YL
authors.lastname: Sa
authors.forename: Qiang
authors.initials: Q
authors.lastname: Fu
authors.forename: Jiong
authors.initials: J
authors.lastname: Zhang
authors.forename: Hong
authors.initials: H
authors.lastname: Xie
authors.forename: Chao
authors.initials: C
authors.lastname: Feng
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008875:Middle Aged; D014522:Urethral Diseases / Q000150:complications / Q000601:surgery*; D014525:Urethral Stricture / Q000150:complications / Q000601:surgery*; D014548:Urinary Fistula / Q000150:complications / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods; D014624:Vaginal Fistula / Q000150:complications / Q000601:surgery*; D055815:Young Adult