Everted saphenous vein graft for long-segment urethral strictures in patients with tobacco-exposed oral mucosa.

A male in his early 50s with a 20-year history of chronic tobacco use, presenting with a long anterior urethral stricture measuring 11 cm. The buccal and lingual mucosae were unsuitable for grafting. The patient underwent Stage I urethroplasty. Substitution urethroplasty was performed after 6 months using a dorsal onlay everted saphenous vein graft (eSVG) harvested from the right saphenous vein. Postoperative follow-up at 1, 3 and 6 months showed significant symptom improvement, with the International Prostate Symptom Score decreasing from 18 preoperatively to 6 at 6 months. Uroflowmetry showed an increase in peak flow rate from 3.6 mL/s to 18 mL/s, and the Quality of Life score improved from 3 to 1.5. At 6 months, no recurrence of stricture was noted. This case highlights eSVG as an effective solution for long anterior urethral strictures in patients with chronic tobacco use and poor oral mucosa, providing long-term functional success.