Short-Term Outcomes Following Transurethral Dorsal Buccal Graft Urethroplasty for Female Urethral Strictures

Female urethral strictures remain a challenging clinical entity with limited data on optimal reconstructive techniques. This study presents 12-month clinical and patient-reported outcomes following a novel transurethral approach to dorsal inlay buccal graft urethroplasty.

We evaluate the outcomes of consecutive female patients with urethral strictures treated via dorsal inlay buccal graft urethroplasty from October 2021 to November 2024. Preoperative evaluation included cystoscopy, uroflowmetry, and/or voiding cystourethrogram. Follow-up at 4 and 12 months included cystoscopy, uroflowmetry, and patient-reported outcomes measured via the Global Response Assessment. Success was defined as absence of recurrence on cystourethroscopy.

Twenty-one patients were included in the study, with 95% having undergone prior treatments (90% dilation/DVIU and 9% urethroplasty). Stricture locations varied across the distal (33%), mid (19%), proximal (19%), and multifocal/pan urethral (19%). The median operative duration was 60 min (IQR: 56-86) and all were discharged on the day of surgery. Nineteen patients (90%) underwent a dorsal inlay procedure, while two (10%) required combined dorsal and ventral inlay due to obliterative stricture. No complications were observed. The median follow-up was 13.2 (IQR: 5.1-23.5) months, during which time 1 patient underwent retreatment for recurrent stricture. Clinical success was 95% at 4 months and 92% at 12 months. Median peak urinary flow rate preoperatively versus 4-month postoperatively was 7.0 cc/s versus 13.0 cc/s (p = 0.20) and at 12-month postoperatively was 13.3 cc/s (p = 0.50). 90% of patients reported improvement on the Global Response Assessment. There were no cases of de novo stress urinary incontinence.

This novel transurethral dorsal inlay buccal graft urethroplasty offers a safe and efficient treatment for female urethral strictures with durable clinical and patient-reported outcomes at 12 months. The technique's minimal urethral mobilization translates into shorter operative times and a low risk of stress incontinence, making it a promising alternative to traditional approaches.