Dorsal-onlay buccal mucosal graft urethroplasty for female urethral stricture: a single-center experience

Female urethral strictures (FUS) present with nonspecific urinary symptoms and are often initially managed with urethral dilation despite poor long-term efficacy. Buccal mucosa graft (BMG) urethroplasty remains underutilized in the treatment of FUS. We report our early and medium-term outcomes using dorsal-onlay BMG urethroplasty for FUS.

A retrospective review of 25 women treated with BMG urethroplasty for FUS was performed. All patients had a voiding cystourethrogram three weeks postoperatively. Success was defined as low post-void residuals and not requiring further interventions for FUS. Recurrence was diagnosed by cystoscopy.

The median patient age was 55 (45-61) years. Most common presenting symptoms included obstructive voiding (70%) and urinary retention (56%). Stricture etiology was mostly unknown (47%). Most patients had previous urethral dilation(s) (71%) and one patient had a prior urethroplasty with vestibule flap. Median stricture length was 2 (2-3) cm and most involved the distal urethra (67%). Median follow-up was 12 (3-45) months. Five patients had stricture recurrence (20%) further managed with intermittent catheterization (2), urethral dilation (1), or direct visual urethrotomy (2). Median time to recurrence was 9 months (5-33) months. There were no cases of de novo stress urinary incontinence and patient-reported outcomes showed no significant change, though data were limited.

BMG urethroplasty is an effective treatment for FUS with promising outcomes at medium-term follow-up. Irritative urinary symptoms may persist despite obstruction relief for which patients must be counseled of preoperatively. De novo SUI was not observed. The timing of stricture recurrence varies, highlighting the need for long-term follow-up.