Title: Meatal-sparing dorsal onlay vaginal graft urethroplasty

Abstract

Objectives: A case of meatal-sparing dorsal onlay vaginal graft urethroplasty as a variation of the conventional dorsal onlay urethroplasty is described as a definitive treatment of female urethral stricture with favourable results. Scope: Urethral stricture in females is a rare entity presenting with voiding lower urinary tract symptoms caused by urethral trauma or infection. It is diagnosed by urethral calibration as less than 14 F along with features of bladder outlet obstruction on urodynamics and a narrowed urethra as seen on urethroscopy or VCUG. Conservative options include urethral dilation whereas urethral reconstructive approaches can be by the dorsal or the ventral route with the use of various grafts (buccal/ lingual/ vaginal). Methods: A surgical video presents a step-wise procedure of meatal-sparing dorsal onlay vaginal graft urethroplasty. Results: The urethra is dissected in the dorsal plane by a suprameatal inverted-U shaped incision and a dorsal urethrotomy made over the strictured segment, sparing the meatus. Not including the meatus here avoids a widened neo-meatus and possible spraying of the urinary stream. Meticulous dissection and staying close to the strictured fibrous urethra preserves sexual function and limits blood loss from the clitoral neurovascular bundle which is in close proximity; adding to the advantages associated with the dorsal conventional approach. Conclusion: Meatal-sparing dorsal onlay vaginal graft urethroplasty can be performed as a slight variation of the standard dorsal urethroplasty in mid and proximal urethral strictures with excellent results.