Expertise Area 2.2: Rare diseases and conditions affecting the female urethra

The occurrence of urethral stricture in females is rare, necessitating astute diagnostic measures to distinguish stricture from the more common functional obstruction. Traditional therapeutic interventions, such as dilatation and urethrotomy, demonstrate a success rate of less than 50%, underscoring the need for more effective alternatives. Consequently, urethral reconstruction has been prioritised as the treatment of choice when minimally invasive options do not yield satisfactory results. A variety of approaches, including urethral meatotomy and flap or graft urethroplasty (utilising vaginal, vestibular, bladder flaps, labia minora grafts, and buccal mucosal grafts), have been proposed. These graft-and flap-based methods have shown promising success rates, coupled with a less than 10% risk of stress urinary incontinence. However, the optimal surgical approach is inconclusive without comparative studies between these techniques. Therefore, referral to specialised centres with expertise in female urethral reconstruction is highly recommended. Female urinary fistulae, although rare, substantially impact an individual’s quality of life. In regions with inadequate healthcare systems, these fistulae often result from obstetric complications. Conversely, in developed nations, they primarily arise as a complication of pelvic surgery. Conservative treatment offers limited success for small and nonradiation fistulae. Depending on the fistula’s location and size, surgical interventions can have transvesical, transperitoneal, and transvaginal approaches. Using different flap tissues in abdominal or vaginal procedures can help mitigate the risk of recurrence, particularly for complex fistulae. Successful repair of irradiated fistulae may even necessitate preliminary urinary diversion with the interposition of nonirradiated tissues.