Long-term outcomes after buccal mucosa graft urethroplasty: a single-center cohort with 7-year median follow-up and systematic review of the literature.

INTRODUCTION AND

OBJECTIVES

Buccal mucosa graft urethroplasty (BMGU) is the standard therapy for recurrent and complex urethral strictures. Data on outcomes beyond 5 years are scarce. This study analyzes long-term results after BMGU and compares them systematically with published cohorts.

MATERIAL AND

METHODS

Patients who underwent BMGU between 1996 and 2015 were identified. Exclusion criteria included female sex and prior hypospadias repair. Details of patient selection are reported in the Results section. A systematic review of the literature was conducted in accordance with the PRISMA statement.

RESULTS

The response rate was 49% (115/237). Median age at surgery was 62 years. Patients had a median of 2 prior operations. Most commonly, internal urethrotomy (92%), dilatation (30%), and open reconstruction (11%) were performed. Median stricture length was 4.5 cm. Recurrence rate was 20% after a median follow-up of 7 years. Median time to recurrence was 70 months. In our cohort, longer operation duration and stricture localization, particularly bulbar and combined bulbar+penile strictures, were identified as risk factors for recurrence (p=0.002 and p=0.016, respectively). Across 14 studies (median follow-up 5-14.3 years, 7-733 patients), the pooled recurrence rate was 16.2% (362/2241), with stricture length, localization, prior surgery, lichen sclerosus, radiation, and infection as the most frequently reported risk factors.

CONCLUSION

In our cohort with 20% recurrence rate after 7 years and across 14 long-term series with a pooled recurrence rate of 16.2%, BMGU consistently achieves durable long-term patency and should be preferred over repeated endoscopic procedures for recurrent or complex urethral stricture disease.