This study evaluates the long-term outcomes and success rates of ventral inlay buccal mucosal graft urethroplasty (Vi-BMGU) versus dorsal onlay buccal mucosal graft urethroplasty (Do-BMGU) for female urethral stricture (FUS) disease. Diagnosing FUS often relies on urethroscopy to visualize scarred mucosa, and substitution urethroplasty is the preferred treatment due to its high success rate. Since male buccal mucosal graft urethroplasty outcomes tend to decline within 2-5 years, this study aims to assess the longevity of Vi-BMGU and Do-BMGU for females. Data was retrospectively analyzed from patients treated with Vi-BMGU or Do-BMGU from March 2016 to October 2021, with a minimum follow-up of 2 years. According to institutional protocol, distal and mid urethral strictures were treated with dorsal onlay BMGU, while proximal and pan urethral strictures were treated with ventral inlay BMGU. Primary outcomes included long-term success rates, while secondary outcomes measured intraoperative blood loss, surgery duration, and post-operative pain scores.
In total, 28 patients underwent Vi-BMGU and 20 had Do-BMGU, with a median follow-up of 37 months. Both techniques showed significant improvements in AUA symptom scores, maximum urine flow (Qmax), and post-void residuals (PVR), except in five cases (3 in Vi-BMGU, 2 in Do-BMGU). Both methods had similar overall success rates (89% for Vi-BMGU and 90% for Do-BMGU), with no significant differences in AUA scores, PVR, or Qmax between groups. Notably, intraoperative blood loss, pain scores, and surgery duration were significantly lower in Vi-BMGU. The findings indicate that both techniques offer effective long-term outcomes, with ventral inlay urethroplasty showing benefits in terms of reduced blood loss, shorter surgery time, and less post-operative pain.
