Female Dorsal Buccal Mucosal Graft Urethroplasty: Implications for Urinary Continence and Sexual Function

Dorsal buccal mucosal graft urethroplasty (DBMGU) is an established surgical approach for female urethral stricture. However, its functional outcomes, particularly those related to sexual function, de novo urinary incontinence, and coital incontinence, have not been comprehensively evaluated.

To evaluate the outcomes of DBMGU with respect to female sexual function, de novo urinary incontinence, and coital incontinence, in addition to overall surgical success.

This prospective, nonrandomized cohort study included sexually active women who underwent DBMGU. Preoperative evaluation included uroflowmetry (UF) and the Female Sexual Function Index (FSFI). Operative data, including perioperative complications and postoperative pain measured using the Visual Analog Scale (VAS) on the first postoperative day, were recorded. At 6 months postoperatively, all patients underwent repeat UF and completed the FSFI, the 3 Incontinence Questions (3IQ) to assess de novo urinary incontinence, and the Patient Global Impression of Improvement (PGI-I) to assess subjective outcomes. Data regarding de novo coital incontinence were noted, and the need for any additional intervention due to recurrent urethral stricture was collected to determine the objective cure.

A total of 27 patients were included, with a median age of 42 years (range: 22-56) and a median follow-up period of 3 years (range: 6 months-6 years). Two patients had suprapubic cystostomy before surgery; the remaining 25 patients had a median preoperative Q_max of 6 mL/s (range: 2-10). The median operative time was 65 min (range: 45-90), and the median operative VAS score was 6 (range: 3-8). Two patients experienced Clavien-Dindo Grade II complications (one vaginitis and one severe urinary urgency), and one patient experienced a Clavien-Dindo Grade III complication due to bleeding at the graft harvest site, which was treated with bipolar cauterization. The median postoperative Q_max increased to 25 mL/s (range: 8-35). One patient required a single endoscopic dilatation for recurrence, resulting in an objective cure rate of 96.2%. One patient reported a PGI-I score of 5; the remaining 26 patients had a median PGI-I score of 2 (range: 1-2), corresponding to a subjective cure rate of 96.2%. All patients were continent according to the first item of the 3IQ, and no cases of de novo coital incontinence were reported. No statistically significant differences were observed between preoperative and postoperative total FSFI scores or most domain-specific subscores, except for a change in the desire domain (p = 0.01).

Dorsal onlay buccal mucosal graft urethroplasty shows high objective and subjective cure rates in women with female urethral stricture disease (FUSD). Our findings suggest that this procedure does not significantly impair sexual function or cause de novo urinary incontinence.