Johanson's Stage II Urethroplasty with Inlay Buccal Mucosal Graft

Urethral stricture disease poses a significant reconstructive challenge, particularly in patients with long-segment strictures or those associated with lichen sclerosus. Staged urethroplasty remains a reliable and well-established approach in such complex cases. This case series evaluates the outcomes of Johanson's Stage II urethroplasty using inlay buccal mucosal grafts performed at a tertiary care centre. A retrospective review was conducted of patients who underwent Stage II urethroplasty following prior Stage I reconstruction. Preoperative assessment included uroflowmetry and retrograde urethrography, and an inlay buccal mucosal graft was used in selected cases requiring urethral augmentation. Patients were followed to assess functional outcomes and postoperative complications. Successful voiding was achieved in 90% of patients, with postoperative maximum urinary flow rates exceeding 15 mL/s. Two patients developed minor postoperative complications, which were managed conservatively. Cosmetic outcomes and sexual function were satisfactory in the majority of patients. Staged urethroplasty with buccal mucosal graft augmentation remains a gold-standard technique for the management of complex urethral strictures, offering excellent functional outcomes and durable results.