Distal intramural urethral pathology in women

Purpose: We reviewed the evaluation of distal intramural urethral pathology in women and its management using urethral dilation and general anesthesia. Materials and Methods: After receiving institutional review board approval we reviewed consecutive charts of women who underwent urethral dilation under general anesthesia for distal intramural urethral pathology. The pathological condition was defined as bothersome lower urinary tract symptoms with distal urethral narrowing and proximal ballooning on lateral voiding cystourethrogram. Patients with extramural, intraluminal or nondistal urethral pathology or neurogenic bladder were excluded from study. Success was defined as complete or major lower urinary tract symptom improvement 6 months after 1 urethral dilation using general anesthesia and no need for a repeat or another procedure. Results: Eight of 101 cases (8%) reviewed between 1998 and 2010 were lost to followup at less than 6 months. Of the remaining 93 patients with a mean ± SD age of 52 ± 16 years and a mean followup of 46 ± 37 months 47 (51%) were classified as success. The failure group had a mean age of 50 ± 16 years and a mean time to failure of 8 ± 12 months. A history of urethral dilation was more common in the failure group (17% vs 39% cases, p = 0.02). Conclusions: Urethral dilation using general anesthesia is effective in some women with distal intramural urethral pathology diagnosed after extensive evaluation, including imaging and urodynamics. Distal intramural urethral pathology is a rare entity and these results are not applicable to women with nonspecific lower urinary tract symptoms.