This study evaluates the long-term success of ventral inlay buccal-mucosal graft urethroplasty (Vi-BMGU) versus dorsal onlay buccal mucosal graft urethroplasty (Do-BMGU) in treating female urethral strictures (FUS). Urethroscopy remains essential in diagnosing FUS, with substitution urethroplasty offering the highest success rates. Given the observed trend of outcome deterioration within 2–5 years in male buccal graft urethroplasty, this study examines the durability of these procedures in female patients. A retrospective analysis was conducted on patients who underwent Vi-BMGU or Do-BMGU from March 2016 to October 2021, each with at least a 2-year follow-up. Institutional protocol guided the approach: distal and mid-urethral strictures received dorsal onlay BMGU, while proximal and pan-urethral strictures received ventral inlay BMGU.
Primary outcomes included long-term success rates, with secondary outcomes assessing intraoperative blood loss, surgery duration, and post-operative pain scores. Patients were monitored using AUA symptom scores, uroflowmetry, and post-void residual (PVR) urine measurements. Failure was defined by increased AUA scores, a maximum flow rate (Qmax) below 12 cc/s, and failure to calibrate with an 18 Fr catheter. Among the 48 patients (28 in the Vi-BMGU group and 20 in the Do-BMGU group), median follow-up was 37 months. Improvements in AUA scores, Qmax, and PVR were seen in all but five patients. No significant differences in AUA, PVR, or Qmax were found between groups. However, Vi-BMGU showed significantly lower intraoperative blood loss (30 vs. 80 ml), pain scores (4 vs. 8 on VAS), and shorter surgery duration (25 vs. 65 minutes). Success rates were similar, with 89% for Vi-BMGU and 90% for Do-BMGU.
In conclusion, both Vi-BMGU and Do-BMGU are safe and effective for FUS, with comparable long-term success rates. Vi-BMGU additionally offers advantages in terms of reduced blood loss, pain, and operative time. No external funding was provided for this study.
