Buccal versus Vaginal Graft Urethroplasty in Female Urethral Stricture: A Systematic Review and Meta-Analysis

This study is aimed at comparing success rate, maximum flow rate (Q_max), and post-void residual volume (PVR) between the buccal mucosal graft (BMG) and vaginal wall graft (VWG) through a meta-analysis of studies commonly performed by urogynecologists.

A systematic review was performed in April 2024, including retrospective, prospective, and comparative studies excluding duplicates, review, editorial comments, case reports, systematic reviews, meta-analyses, and therapeutic indications. Heterogeneity in the meta-analysis was assessed using I² statistics.

The meta-analysis incorporated a quantitative assessment of 18 original articles. The studies in meta-analysis evaluated various parameters, including Q_max, PVR, and success rates of surgical outcomes. The I² statistics indicated no heterogeneity in Q_max and success rates between BMG and VWG, both with I² = 0% and high heterogeneity for PVR values (I² > 50%). According to the results, Q_max values were 23.266 for BMG and 24.945 for VWG, PVR values were 14.651 for BMG and 23.009 for VWG, and success rates were 86.2% for BMG and 89.8% for VWG. A definition of success across the studies was established by achieving Q_max > 15 ml/s at 3 months, a PVR < 30 ml, and an improvement in the American Urological Association symptom scores.

Meta-analysis indicates no significant differences between VWG and BMG regarding Q_max, PVR, and the overall success rate of surgical outcomes. Both BMG and VWG graft options demonstrate effectiveness in female urethroplasty. Graft choice should be based on graft availability and feasibility, patient characteristics, and the surgeon's preference and expertise.