Factors predicting success following female urethroplasty: an observational study.

BACKGROUND: Female urethral stricture disease (FUSD) is an uncommon but challenging cause of bladder outlet obstruction in women. Owing to the poor long-term durability of urethral dilatation and optical internal urethrotomy, urethroplasty has emerged as the preferred definitive treatment. Ventral inlay and dorsal onlay buccal mucosal graft urethroplasty (BMGU) are widely practiced techniques; however, data on preoperative predictors of failure remain limited. This study aimed to identify factors associated with outcomes following female urethroplasty. METHODS: We retrospectively analyzed 91 adult female patients with FUSD who underwent BMGU between January 2016 and March 2024 at a tertiary care center. Diagnosis was established based on symptomatic obstruction supported by uroflowmetry, elevated post-void residual urine, failed urethral calibration, and mandatory cystoscopic confirmation of anatomical narrowing. Stricture-free survival was evaluated using Kaplan–Meier analysis, and logistic regression was used to identify predictors of failure. RESULTS: The mean age was 44 ± 13.5 years. Fifty-seven patients underwent ventral inlay and 34 underwent dorsal onlay urethroplasty. Thirteen patients (14.3%) developed recurrence during follow-up. Factors significantly associated with failure included older age, higher baseline AUA symptom scores, higher post-void residual urine, lower preoperative Qmax, prior urethral dilatation, longer stricture length, and panurethral involvement (all p < 0.05). Stricture-free survival rates were 99% at 6 months, 97.7% at 1 year, 86% at 2 years, and 77% at 3 years. No significant difference in recurrence rates was observed between ventral and dorsal techniques (p = 0.93). CONCLUSIONS: Failure following female urethroplasty is primarily associated with disease severity and extent rather than reconstructive technique. Ventral and dorsal BMGU provide comparable outcomes, emphasizing the importance of preoperative risk stratification and long-term surveillance.