Female urethral surgery: a single-referral-center experience with practical tips and tricks

Elisa Berdondini¹, Ahmed Eissa², Mauro Silvani¹, Andrea Margara¹, Mauro Gacci³, Salvatore Voce⁴, Giulio Reale⁴, Juan Ignacio Martinez-Salamanca⁵, Giuseppe Maiolino^5,*
1 Department of Reconstructive Surgery, Clinica Sedes Sapientiae, Turin and Nigrisoli Hospital, Bologna, Italy
2 Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
3 Department of Urology, Careggi Hospital-University of Florence, Florence, Italy
4 Department of Urology, Santa Maria delle Croci Hospital, Ravenna, Italy
5 Department of Andrology and Sexual Medicine, Cátedra de Empresa UFV-The Lyx Institution en Salud Urológica, Universidad Francisco de Vitoria, Madrid, Spain
* Corresponding Author: Giuseppe Maiolino. Email: email
(This article belongs to the Special Issue: Female Urethral Reconstruction: Tips And Tricks)

Canadian Journal of Urology https://doi.org/10.32604/cju.2026.074216

Received 06 October 2025; Accepted 30 March 2026; Published online 08 July 2026

Abstract

Introductions: Female lower urinary tract symptoms (LUTS) are heterogeneous and often reflect bladder outlet obstruction (BOO) from anatomic urethral disease. Evidence guiding surgery remains fragmented. This study aimed to evaluate surgical and patient-reported outcomes after reconstructive surgery for female anatomical urethral disease. Materials and Methods: We retrospectively analyzed a prospectively maintained, single-surgeon database of women undergoing urethral surgery (January 2017–April 2024) for female urethral stricture (FUS), female urethral diverticulum (FUD), or periurethral masses. Standardized preoperative assessment was applied; procedures included dorsal inlay buccal mucosa graft (DMG), ventral onlay grafts (VOG, buccal or vaginal), partial diverticulectomy, and mass excision with selective reinforcement. Outcomes comprised perioperative events, reintervention, and patient-reported symptoms (modified International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms long form, ICIQ-FLUTS LF), compared pre–post using Wilcoxon tests. Results: 116 women (mean age 50.6 ± 13.8 years) were included. Ventral urethroplasty (n = 62) predominantly used buccal grafts (88.7%); dorsal urethroplasty was uniformly DMG (n = 13). FUD (n = 31) underwent partial diverticulectomy with periurethral fascial reconstruction; periurethral masses (n = 10) were managed according to pathology with frequent fascial reinforcement. Complication rates were low in ventral (4.8%) and dorsal (7.7%) urethroplasties, modest for masses (10%), and higher after FUD (32.2%), although largely self-limited pain. Persistent stress incontinence occurred in two FUD patients. At a median 32-month follow-up, most ICIQ-FLUTS domains improved significantly across groups (storage, voiding, post-micturition, pain/burning); incontinence improved after ventral urethroplasty and FUD. Conclusions: In experienced hands, reconstructive surgery for female urethral disease yields durable symptom relief with low morbidity. Technique selection that preserves sphincteric function and periurethral support, combined with selective use of grafts, optimizes continence and minimizes complications.