Comparative Effectiveness of Treatment Methods for Female Urethral Stricture: A Systematic Review and Meta-Analysis

Vorobev V.А., Kogan M.I., Bogdanov A.B., Sharakshinov B.K., 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 Сontinuing Professional Education» of the Ministry of Health of the Russian Federation, Moscow, Russia

Objective. To identify the main surgical treatment methods for female urethral strictures and evaluate their efficacy and safety. Materials and Methods. A systematic literature review was conducted in accordance with PRISMA guidelines using databases such as PubMed, Embase, and others. The review included studies comparing ≥2 surgical treatments for female urethral strictures. Eligible studies comprised randomized controlled trials (RCTs), prospective and retrospective cohort observational studies (OS), and case series with ≥10 patients. Inclusion criteria were: confirmed female urethral stricture, comparison of at least two surgical approaches, and available data on primary outcomes (urethral patency or absence of recurrence) as well as secondary outcomes (recurrence, complications, functional outcomes, patient satisfaction, and quality of life). The quality of evidence was assessed using the GRADE system. A meta-analysis was performed with pooled success rates and heterogeneity analysis (I²). Results. A total of 37 studies (including 1 RCT and 36 observational studies) involving 1,279 patients were included. The main surgical interventions were simple dilation, internal optical urethrotomy (IOU), and various urethroplasty techniques. Due to the frequent sequential or combined use of dilation and IOU within single studies, they were grouped under «dilation-based methods» (DM). Urethroplasty approaches included buccal mucosa graft (BMG) urethroplasty, vaginal or labial flaps (e.g., labia minora flap [LMF]), and various graft combinations. In the meta-analysis, urethroplasty demonstrated significantly higher pooled success rates (PSR) or absence of recurrence – 92% (95% CI: 89–95%) with mean follow-up >2 years – compared to dilation (47%; 95% CI: 39–55%). BMG urethroplasty achieved cure rates of 88–95% over 2–3 years of follow-up, with comparable outcomes for vaginal flaps (VF) and LMF (78–94%). Differences between urethroplasty techniques were minor. Combined techniques (e.g., BMG + VF for long strictures) also yielded good patency rates, though data were limited. Urethroplasty significantly improved urodynamic outcomes: mean maximum urinary flow rate (Qmax) increased from 6–8 mL/s to 20–25 mL/s, and lower urinary tract symptom scores (e.g., AUA-SS) decreased from 22 to 6 points. Quality of life also improved significantly. In contrast, dilation-based methods offered only temporary symptom relief, with over 50% of patients experiencing stricture recurrence and requiring repeat interventions within the first year. Meta-analysis showed that the risk of stricture recurrence (RS) after dilation was significantly higher than after urethroplasty (risk ratio 3:1, p<0.001). The overall complication rates were low across all groups. The most common complication after urethroplasty was transient stress urinary incontinence (5–15%), typically resolving within ≤6 months. Donor site morbidity for grafts and flaps was minimal. Comparative analysis revealed no significant differences in complication rates between various urethroplasty techniques. Conclusions.This systematic review indicates that two primary surgical strategies exist for treating female urethral strictures: dilation-based methods and reconstructive urethroplasty. Both approaches are safe, but only urethroplasty consistently demonstrated high efficacy regardless of the specific technique or tissue used. Further prospective randomized trials are urgently needed to provide more robust evidence on the effectiveness of surgical treatments and long-term outcomes, including direct comparisons between urethroplasty techniques and their impact on urinary function and overall quality of life in women.

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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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