Technical modifications in dorsal onlay female urethroplasty: Time to make way for amendments

Surgical treatment for female urethral stricture is varied and lacks consensus. Dorsal and ventral approaches of urethroplasty have comparable success rate with debatable limitations. We describe modifications in dorsal onlay graft urethroplasty to mitigate the surgical limitations and improve functional outcomes. We retrospectively analyzed 8 patients with strictures treated with dorsal onlay urethroplasty at our center. The inclusion criteria were American Urology Association (AUA) score >20, calibration 12 mL/s, without requiring any further intervention. The mean age was 50.5±10.6 years. Statistically significant improvements in mean AUA score [14.5±2.20 (p=0.012)], Qmax [23.63±2.44 (p=0.012)], post-void residual urine [107.88±40.37 (p=0.012)], and sexual function scores [6.833±2.23 (p=0.027)] were noted at a mean follow-up of 3 months. Distal strictures were more common. Mean urethral caliber was 9.62 Fr. No cases of de novo incontinence or sexual dissatisfaction were reported. In our experience, the dorsal onlay technique works well, but without a comparative evidence for ventral onlay, it is difficult to conclude that one is preferred over the other.