Evaluating intermediate-term functional outcomes of double-sided buccal mucosal graft urethroplasty for anterior urethral stricture.

AIM OF THE STUDY: This study aims to evaluate the urinary and sexual outcomes following double-sided buccal mucosal graft (BMG) urethroplasty in patients with near-obliterated anterior urethral strictures.

METHODS

We conducted a retrospective analysis of patients who underwent double-sided BMG urethroplasty between June 2017 and September 2024. We included only patients with complete perioperative data and a follow-up period of at least 6 months. The double-sided approach was utilized for nearly obliterated stricture segments (less than 6 French) during augmentation of long bulbar and bulbopenile urethral strictures (> 2 cm). The primary outcomes measured was the success rate, defined as the absence of need for secondary intervention, while the secondary outcome was the changes in erectile function assessed using the International Index of Erectile Function (IIEF).

RESULTS

The final analysis included 52 patients, median age of 42 years, with a median stricture length of 4 cm (40 patients with bulbar and 12 with bulbo-penile strictures). Among the cohort, 30 (57.7%) patients were treated via a ventral approach with dorsal inlay plus ventral onlay BMG urethroplasty, while 22 patients (42.3%) were treated with ventral inlay plus dorsal onlay grafting via either a dorsal or dorsolateral approach. There were no intraoperative complications, and only one patient (2%) experienced a major postoperative complication, namely a perineal hematoma, which required re-exploration and evacuation. Six patients showed contrast leakage on urethrograms post-catheter removal, effectively managed with additional catheterization for two weeks. A significant improvement in Q-max values was noted from baseline to six months after surgery (5 vs. 20 ml/sec, p < 0.001). After a median follow-up of 24 months (IQR 18-32 months), stricture recurrence was observed in 4 patients (7.7%), all of whom had prior failed urethroplasties and longer stricture lengths (median 8 cm, range: 5-10 cm). Additionally, IIEF scores showed preserved or improved sexual function in most patients, with only 2 (3.8%) patients.

CONCLUSION

Double-sided buccal mucosal graft urethroplasty demonstrates favorable urinary and sexual outcomes in managing near-obliterated bulbar and bulbo-penile urethral strictures. Further long-term studies are warranted to broaden the understanding of its efficacy and sustainability in diverse patient populations.