title: Intermediate outcomes after female urethral reconstruction: graft vs flap.
abstract: OBJECTIVE
  To evaluate the outcomes of women after urethral reconstruction with a vaginal flap urethroplasty (VFU) or dorsal buccal mucosal graft (BMG).
  
  
  METHODS
  We retrospectively identified 10 women undergoing urethral reconstruction between February 2007 and October 2012. All patients had evidence of urethral stricture on cystoscopy and/or urodynamic study indicating bladder outlet obstruction. Recurrent stricture was defined using the same criteria. Follow-up included urethral calibration (>16F), symptom assessment, voiding cystourethrogram, and cystoscopy when there was difficulty voiding or symptoms recurred.
  
  
  RESULTS
  Mean age was 49 years (range, 32-74). The indication for urethral reconstruction was urethral stricture in 9 patients. One woman had a traumatic 2-cm ventral urethral laceration associated with a pelvic fracture. Location was mid in 6 and distal in 4 women. Average stricture length was 1.25 cm (range, 0.2-2). All patients with urethral stricture had previously undergone multiple urethral dilations. There were no major postoperative complications. Two patients undergoing VFU had a recurrent stricture requiring dilation. No patients undergoing dorsal BMG had a recurrent stricture.
  
  
  CONCLUSIONS
  Female urethral reconstruction, either VFU or dorsal BMG, is a safe and successful procedure that should be offered to women with urethral strictures. The dorsal BMG approach is well tolerated and results are promising, but longer-term follow-up is needed. Women should be offered urethral reconstruction as a definitive management option rather than repeated urethral dilations.
authors.affiliation: Institute of Urology, Lahey Hospital & Medical Center, Burlington, MA. Electronic address: casey.kowalik@gmail.com.
authors.forename: Casey
authors.initials: C
authors.lastname: Kowalik
authors.affiliation: Department of Urology, University of Michigan Health System, Ann Arbor, MI.
authors.forename: John T
authors.initials: JT
authors.lastname: Stoffel
authors.affiliation: Institute of Urology, Lahey Hospital & Medical Center, Burlington, MA.
authors.forename: Leonard
authors.initials: L
authors.lastname: Zinman
authors.affiliation: Institute of Urology, Lahey Hospital & Medical Center, Burlington, MA.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Vanni
authors.affiliation: Department of Urology, University of California San Diego Health System, San Diego, CA.
authors.forename: Jill C
authors.initials: JC
authors.lastname: Buckley
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D009061:Mouth Mucosa / Q000637:transplantation; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery; D014525:Urethral Stricture / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods; D014621:Vagina / Q000601:surgery