Penile skin graft versus buccal mucosal graft for anterior urethral strictures in adult urethroplasty- a systematic review and meta-analysis.

BACKGROUND

Urethral strictures are a prevalent condition commonly involving the anterior urethra for which urethroplasty remains the gold standard treatment. BMG and PSG are most widely used for the repair, yet their comparative efficacy remains debated.

METHODS

A systematic literature review was performed consistent with PRISMA guidelines. Literature searches were performed on PubMed, Embase and the Cochrane Library. Studies were considered eligible if they were comparing BMG and PSG for urethroplasty in adult patients with anterior urethral strictures. Statistical analysis was carried out on RevMan 5.4, employing a random-effects model driving pooled odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI). Subgroup analysis and sensitivity analysis was performed.

RESULTS

11 included studies (n = 1018) showed that success rate was significantly higher in PSG compared to BMG (OR: 0.52, P = 0.0004). Analysis of secondary outcomes demonstrated a marginally and statistically significant advantage of PSG in improving IPSS at 6 months (MD: 0.53, P = 0.05) and 18 months (MD: 0.91, P = 0.002) respectively, with a borderline enhancement in erectile function (IIEF-ED) at 18 months (MD 1.27, P = 0.05). No statistically significant differences were observed for other outcomes.

CONCLUSION

In this pooled analysis, PSG was associated with a higher success rate, though this finding must be interpreted with caution due to the inconsistent definitions of success and follow-up durations, variability among surgery methods and graft types. Moreover this meta-analysis demonstrate that PSG in comparison to BMG has modest advantages in urinary and erectile function with comparable outcomes across most secondary parameters, supporting PSG as a viable alternative to BMG.