EURURO Vol. 73 No. 1

Table 1

lists the symptoms present in each patient and

instrumental findings.

Seven of the patients presented with a history of multiple

urethral dilatations. One also had a previous internal

urethrotomy. Another patient had a previous intervention

due to urethral stricture using the Blandy’s technique, with

a stricture recurrence 2 yr afterwards. The last patient was

treated for a third degree cystocele. In this latter case, the

cystocele was successfully treated, although the urinary

symptoms remained.

Voiding cystourethrography gave rise to two different

results. Six of the patients presented with a narrow urethral

segment, with a dilated proximal urethra and bladder neck

during micturition

( Fig. 2 )

. The whole urethra of the three

remaining patients was strictured, reaching up to 1 cm of

the bladder neck and remaining so throughout the whole

time of exploration

( Fig. 3 )

. Also, three patients presented

with bladder trabeculation with cellule formation.

Eight women recovered favorably following catheter

removal. The remaining patient required catheter drainage

for 4 wk. However, after removing the catheter, bladder

function was recovered and the patient was subsequently

able to void normally with no recurrent stricture.

Concerning maximum urinary flow, median values were

6.8 ml/s before the surgical procedure and 21 ml/s in the

last follow-up (

0.01). The median peak flow difference

was 14.2 ml/s (3–35 ml/s) and the median ratio was 3:1.

No immediate or delayed complications or lasting side

effects appeared after surgery. Six of the patients remained

sexually active. The sexual inactivity of the other three

patients was not related to the intervention.

Table 1

lists the

postoperative and preoperative results.

Discussion

FUS is a relatively rare condition, with an approximate

prevalence of 15% of cases with bladder outlet obstruction,

although its true prevalence is still largely unknown

[14] .

Etiology is identifiable in only 50% of the cases

[10] .

In our

study, four of our nine patients presented with FUS due to a

physical trauma with instrumentation, with another two

describing complications while giving birth.

A proper diagnosis is difficult, as the symptoms are often

nonspecific and there is currently no consensus on the

diagnostic criteria for FUS. Subsequently, diagnosis gener-

ally relies on the use of a multitude of tests.

[(Fig._1)TD$FIG]

Fig. 1 – Surgical procedure. A: Midline anterior vaginal wall incisio´n. B: After mobilization of anterior vaginal wall, the urethra is incised ventrally from the

meatus to the point where the stricture is completely open. C: A rectangular-shaped piece of vaginal wall is then selected and the outer external flap border

is mobilized with a wide vascular pedicle. D: The vaginal flap is sutured to the margins of the urethrotomy defect. The inner vaginal flap edge to the closer

urethral margin. E: The outer vaginal flap edge is turned around and sutured to the contralateral edge. F: The vaginal mucosa has been approximated.

E U R O P E A N U R O L O G Y 7 3 ( 2 0 1 8 ) 1 2 3 – 1 2 8

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