Etiology, Presentation, and Treatment of Urethral Stricture in Females: A Systematic Review

Purpose of Review: Female urethral strictures (FUS) are an underrecognized cause of lower urinary tract symptoms (LUTS) and bladder outlet obstruction (BOO) in adult women. Clinical practice remains inconsistent due to limited and heterogeneous evidence. This review aims to summarize current knowledge on the etiology, diagnosis, and management of FUS, identify areas of consensus and controversy, and outline priorities for future research. Recent Findings: Of 290 records screened, 49 studies met inclusion criteria. Idiopathic and iatrogenic causes were most frequent, with trauma, infection, and inflammation less common. Dilation is widely used but shows poor durability. In contrast, graft- and flap-based urethroplasties achieved consistently high success, with no clear advantage of approaches or tissue sources. Summary: Current evidence reveals mixed etiologies and supports substitution urethroplasty as the preferred treatment for most women with FUS, though data remain limited and heterogeneous. Future research should include large, prospective studies to standardize diagnostics, and compare interventions.