Introduction: Female urethral stricture is an uncommon condition that significantly impacts quality of life and results in worse patient-reported outcome measures (PROM). Urethroplasty with different reconstructive techniques remains one of the most accepted treatment options. Current evidence is limited with this type of reconstruction, particularly in female patients. Additionally, published data have not focussed on the PROM after surgical repair. This study aims to determine the success rate, functional, and patient-reported outcomes of dorsal onlay buccal graft in the treatment of female urethral stricture disease.

Methods: Between September 2016 and April 2021, 18 consecutive women treated with dorsal onlay buccal mucosa graft were included in this study. All patients presented with voiding dysfunction after failed attempts of clinic‐based urethral dilations. Clinical data were extracted from medical records, including baseline demographics, etiology of stricture, previous treatment, operative time, length of stay, complications, uroflow findings, urethrocystoscopy, International Prostate Symptom Score (IPSS), Patient Perception of Bladder Condition (PPBC), and Overactive Bladder-Validated 8-question Screener (OAB-V8).  Primary outcome was the success of dorsal onlay buccal graft urethroplasty, defined as no need for further instrumentation, or open surgery and resolution of symptoms without any recurrent stricture.

Results: The most common stricture etiology was iatrogenic (55.56%) or idiopathic (38.89%). Mean age at surgery (standard deviation) was 56.9 (11) years. Mean body mass index was 27.7 (8.1). Mean stricture length was 2.1 (0.84) cm. There were 14 distal urethra stricture (77.7%), two proximal (11.1%), and two pan-urethral (11.1%). The mean followup period was 15.9 (14.6) months. The success rate was 100%. Postoperative average flow rate improved significantly (preoperative 4.54 (3.36) ml/s vs. postoperative 6.95 (3.40) ml/s, p=0.027). Mean postvoid residual decreased significantly (preoperative 173 (167) ml vs. postoperative 92.9 (128) ml, p<0.01). After treatment, IPSS, OAB-V8, and PPBC scores improved significantly (p<0.01). The mean operation time was 88.9 (12.5) minutes. Mouth pain and dryness symptoms were reported in two patients (11.1%).

Conclusions: The early and medium-term results demonstrate that dorsal onlay buccal mucosa graft urethroplasty is a safe and successful management option with a high success rate. Functional and patient-reported outcomes significantly improved after surgery.