Reconstruction of the female urethra during its destruction: a systematic review and meta-analysis

Vorobev V.А., Kogan M.I., Bogdanov A.B., Loran O.B.

1) Bashkir State Medical University, Ufa, Russia; 2) Irkutsk State Medical University, Irkutsk, Russia; 3) Rostov State Medical University, Rostov-on-Don, Russia; 4) State Budgetary Healthcare Institution of the city of Moscow «Moscow Multidisciplinary Scientific and Clinical Center named after S.P. Botkin» of the Department of Health of the City of Moscow, Moscow, Russia; 5) Federal State Budgetary Educational Institution of Additional Professional Education «Russian Medical Academy of Continuing Professional Education» of the Ministry of Health of the Russian Federation, Moscow, Russia

In accordance with the PRISMA protocol, a comprehensive literature search was conducted, and based on a systematic review and meta-analysis, the effectiveness of various surgical approaches for complete or partial urethral destruction in women was evaluated. A total of 36 studies were included, encompassing more than 500 female patients with severe urethral injury. The analysis incorporated retrospective case series, cohort and comparative studies, as well as one systematic review. The primary outcomes assessed were urethral patency restoration, urinary continence, recurrence rate, complications, and the need for re-interventions. Statistical analysis included a meta-analysis of success proportions using a random-effects model; the level of evidence was evaluated according to the GRADE system.
The best outcomes were observed with urethroplasty using autologous tissues (buccal mucosa, vaginal and labial flaps), which provided long-term urethral patency (88.2%; 95% CI, 82–93%) and preservation of continence. Other urinary diversion techniques (urethroclesis, suprapubic fistula, Monti procedure) achieved continence in the majority of patients with severe comorbidities (success rate 78%), but were associated with a high incidence of complications, including infections, stone formation, and progressive renal failure.
Tissue urethroplasty remains the most effective and safest method of urethral reconstruction in women. Minimally invasive procedures should be regarded as temporary measures, while diversion operations should be reserved for the most severe cases.

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About the Authors

Corresponding author: V.A. Vorobev – Doctor of Medical Sciences, M.D., Professor of the Department of Faculty Surgery and Urology at the Federal State Budgetary Educational Institution of Higher Education “Irkutsk State Medical University” of the Ministry of Health of the Russian Federation, Irkutsk, Russia; Associate Professor of the Department of Urology and Oncology of the Federal State Budgetary Educational Institution of Higher Education “Bashkir State Medical University” of the Ministry of Health of the Russian Federation, Ufa, Russia; E-mail: denecer@yandex.ru

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