Four experts will discuss surgical approaches for female urethral stricture disease during a Monday morning surgical techniques presentation titled Tips & Tricks: Female Urethral Stricture Disease. E. Ann Gormley, MD, professor of Surgery at Geisel School of Medicine at Dartmouth, will moderate the 45-minute presentation, which begins at 7:45 am during the Prime Time plenary session in the Esplanade Ballroom at Moscone South.
“In theory, female urethral stricture disease is not terribly common,” Dr. Gormley said. “However, we know it’s a diagnosis that is quite commonly billed. So even though this session will focus on surgical tips and tricks, we will first introduce this topic and talk about the prevalence of the problem.”
Historically, female urethral stricture disease has been treated with dilation.
“While there will be situations where a clinician may dilate a urethral stricture, all of us on the panel agree that dilation isn’t a sustainable way to treat this problem,” Dr. Gormley said. “You may do it once to get someone out of trouble, but if the problem recurs then you need to do a more durable procedure. However, before you discuss treatment options, you have to review other factors a clinician should consider before diagnosing urethral stricture in a female patient.”
Dr. Gormley and the panel of expert surgeons will share strategies for ruling out conditions that mimic the symptoms of female urethral stricture. Anne Cameron, MD, FRCSC, associate professor of Urology at the University of Michigan, will review primary bladder neck obstruction.
“We think primary bladder neck obstruction is often confused with urethral stricture, and the treatment is not the same,” Dr. Gormley said. “So Dr. Cameron, who is fellowship trained in female pelvic medicine and reconstruction, will focus on how one differentiates between the two and how one should treat a primary bladder neck obstruction compared to how one should surgically treat a diagnosed urethral stricture.”
The panel will also review the use of vaginal flaps and buccal flaps for treating female urethral stricture.
Rajveer Purohit, MD, MPH, Director of Reconstructive Urology and associate professor of Urology at Icahn School of Medicine at Mount Sinai Hospital, will review vaginal flap urethroplasty. Bahaa Malaeb, MD, assistant professor of Urology and Medical Director of the Taubman Center Urology Clinic at the University of Michigan, will review buccal graft urethroplasty.
“After the presentations, we hope we’ve demonstrated that there are options for female patients with strictures,” Dr. Gormley said. “Vaginal flap urethroplasty is relatively straightforward but other procedures like buccal flaps are more complicated. I think it’s fair to say the more complicated procedures require specialty training beyond urology residency. There are a lot of people trained in female pelvic medicine who may not want to do urethroplasty with a buccal graft.”
Dr. Gormley said attendees will learn to determine which procedure is right for an individual patient and to recognize when a multidisciplinary approach is required.
“Female urethral stricture may be treated by surgeons fellowship trained in female pelvic medicine, but it’s also something that could be treated by someone trained in reconstruction,” she said. “With this particular condition, the quest is to determine the right procedure for a patient and, if necessary, to refer them to the right surgeon regardless of their specialty.”