From failure to success: management of recurrent urethral strictures with buccal mucosa graft

BACKGROUND: The recurrence of urethral strictures after initial buccal mucosa graft urethroplasty (BMGU) can be challenging in reconstructive urology. BMGs are preferred for their durability and high success rates, but managing re-strictures often requires redo urethroplasty. This study evaluates the efficacy, safety, and functional outcomes of redo BMGU in treating recurrent urethral strictures after initial BMGU.METHODS: Patients who underwent redo BMGU after a failed initial BMGU between January 2015 and January 2023 were assessed. Preoperative assessments included urine analysis, post-void urine volume, urethroscopy, urethrography, and uroflowmetry. The surgical procedures involved harvesting buccal mucosa grafts, which were then used in various urethroplasty techniques. In severe cases, a two-stage reconstruction was performed. The post-op urethral catheter was removed after 3 weeks, and a suprapubic catheter was used until urethral patency was confirmed. Follow-up visits were scheduled at 1, 3, and 6 months post-op, and then annually thereafter.RESULTS: Forty-two patients with failed primary repair were identified and treated with redo BMGU. The average stricture length was 3.2 cm, which did not impact the surgery success rate. The follow-up period averaged 32 months. During this time, thirty-nine patients remained free from strictures, resulting in an overall success rate of 92.8%. The mean time to failure in patients was 25.3 months. The overall stricture-free survival rates after 12, 24, and 40 months were 97.5%, 93.3%, and 82.9%, respectively. The mean maximum flow rate increased from 7.6 mL/s preoperatively to 18.4 mL/s at 6 months postoperatively. The most common postoperative complication was nonfebrile urinary tract infection.CONCLUSIONS: Redo BMGU is a reliable and effective option for managing recurrent urethral strictures, offering high success rates and favorable long-term outcomes. Careful preoperative assessment and individualized surgical approaches are crucial for optimizing patient outcomes.