Investigating the Outcomes and Complications of Urethroplasty Using Different Graft Materials in Men With Complex or Recurrent Urethral Strictures

Background Complex and recurrent urethral strictures present significant surgical challenges, with graft-based urethroplasty being the mainstay of treatment. Optimal graft selection remains controversial, particularly between buccal mucosa and penile skin grafts. Objective To compare clinical outcomes, complication rates, and patient-reported satisfaction following urethroplasty using buccal mucosa versus penile skin grafts. Methods This retrospective cohort study was conducted at Nishtar Hospital, Multan, Pakistan, from January 2022 to December 2024. A total of 178 male patients who underwent substitution urethroplasty were included in the study. Data were retrospectively extracted from electronic medical records and surgical logs. Collected variables included patient demographics (age, comorbid conditions like diabetes or smoking status), stricture characteristics (location, length, etiology, previous treatments), surgical details (graft type, operative time, perioperative complications), and postoperative outcomes. Data were analyzed using SPSS Version 26.0 (IBM SPSS Statistics for Windows, IBM Corp., Armonk, NY). Continuous variables were compared using t-tests and categorical variables using chi-square tests, with p < 0.05 considered statistically significant. Results Surgical success rates were higher in the buccal mucosa group at both 12 months (91 (87.5%) vs. 59 (80.2%)) and 24 months (88 (84.6%) vs. 56 (75.6%)), though differences were not statistically significant. Stricture recurrence and graft contracture were lower in the buccal mucosa group (11 (10.6%) vs. 14 (18.9%)) and (four (3.8%) vs. eight (10.8%)), respectively. International Prostate Symptom Score (IPSS) improvement was significantly greater with buccal mucosa grafts (p = 0.04), and patient satisfaction rates were also higher. Complication rates were low in both groups, but oral donor site morbidity was observed in 19 (18%) of buccal mucosa patients. Conclusions It is concluded that buccal mucosa grafts offer superior functional outcomes, lower complication rates, and greater patient satisfaction compared to penile skin grafts in the setting of complex or recurrent urethral strictures. Buccal mucosa should be considered the preferred graft material when feasible.