Meatal-sparing dorsal onlay vaginal graft urethroplasty: widening the surgical horizons of female urethral stricture

Aim of the video Female urethral stricture is an uncommon but challenging entity in the spectrum of female pelvic dysfunctions. There are various reconstructive techniques but none can be recommended over another. We present a case of meatal-sparing dorsal onlay vaginal graft urethroplasty as a surgical variation of the standard dorsal approach. This is a step to improve the results of the dorsal approach and overcome its limitations. Patients and methods In this video we present meatal-sparing dorsal onlay vaginal graft urethroplasty as a modification of the conventional dorsal approach. Results Sexual function can be preserved by dorsal plane dissection away from the clitoral neurovascular bundle. Excessive blood loss is avoided by limited mobilisation and dissection of the urethra. Meatal reconstruction is avoided by slitting the urethra directly over the strictured mid-urethral segment, thus averting a widened meatus and spraying of the urinary stream. Conclusion Female urethroplasty provides excellent cure rates. Meatal-sparing dorsal onlay vaginal graft urethroplasty can be considered in mid- and proximal urethral strictures. This simple and effective approach can widen the surgical horizons in the treatment of female urethral stricture and reduce its complications.