Dorsal Versus Ventral Onlay Buccal Mucosal Graft Urethroplasty in Female Urethral Stricture: A Meta-Analysis

This study aims to systematically compare the efficacy of dorsal onlay buccal mucosal graft urethroplasty (BMGU) and ventral onlay BMGU in the treatment of female urethral stricture (FUS), evaluating key outcomes such as success rate, postoperative maximum urinary flow rate (Qmax), postoperative post-void residual volume (PVR), and postoperative American Urological Association (AUA) score.

A literature search was conducted across PubMed, Embase, Web of Science, and Cochrane Library databases. Statistical analysis was performed using Review Manager 5.3 software and Stata version 18.0, and a random-effects model was applied to analyze data with significant heterogeneity.

Five studies met the inclusion criteria, involving a total of 319 patients (112 with dorsal onlay and 207 with ventral onlay). The pooled analysis showed no significant difference between the two surgical approaches in terms of success rate (relative risk [RR] 1.00; 95% confidence interval [CI] 0.91, 1.10; p = 0.95). At 6 months postoperatively, Qmax (mean difference [MD] -0.88; 95% CI -2.21, 0.46; p = 0.20), PVR (MD 0.74; 95% CI -3.04, 4.52; p = 0.70), and AUA score (MD -0.54; 95% CI -1.24, 0.15; p = 0.13) were similar between the dorsal and ventral groups.

Dorsal onlay BMGU and ventral onlay BMGU show similar efficacy in treating FUS. The choice of surgical approach should be based on individual patient factors, such as the location, severity of stricture, and history of prior treatments.