Comparative Analysis of Dorsal Onlay Buccal Mucosal Graft and Vaginal Wall Graft Urethroplasty for Female Urethral Stricture at a Tertiary Care Centre.

Objective: To compare dorsal onlay Buccal Mucosal Graft (BMG) and Vaginal Wall Graft (VWG) urethroplasty in the management of Female Urethral Stricture (FUS).

Methods: A retrospective analysis was conducted on 33 women undergoing dorsal onlay urethroplasty using BMG (n = 17) and VWG (n = 16) for urethral stricture at a tertiary care centre. Data including patient demographics, comorbidities, stricture characteristics, preoperative, and postoperative Female Sexual Function Index (FSFI) scores and operative outcomes were analyzed. Their preoperative diagnosis was confirmed with uroflowmetry, micturating cystourethrogram, urethral calibration, and urethrocystoscopy. Per urethral catheter was removed after 3 weeks and patients were followed up at regular intervals with urine analysis, uroflowmetry and post void residual urine assessment.

Results: The overall mean age was 47 years (range: 21-75) and follow-up was 16 months (range: 6-26). The overall change in American Urological Association (AUA) symptom score was from 18 to 4, maximum flow rate (Q max) from 5 mL/s to 24 mL/s, Post Void Residual Urine (PVRU) from 110 mL to 10 mL, average operative time of 97 minutes (range: 80 to 118 minutes) with no statistical difference between the 2 groups. Other parameters showed no difference. The overall urethral patency rate was 93.9% with no statistical difference in these groups (0.862). None of the patients developed urinary incontinence.

Conclusions: Dorsal onlay substitution with BMG and VWG shows equivalent outcomes with low complication rate. Substitution urethroplasty elicits a robust and enduring therapeutic response and should be offered to patients presenting with FUS to avoid the adversities of repeated urethral dilatations.