Comparative outcomes of penile skin grafts versus buccal mucosal grafts in urethroplasty for the treatment of extensive anterior urethral strictures

To compare the outcomes of augmentation urethroplasty (AU) performed with either buccal mucosa graft (BMG) or penile skin graft (PSG) in managing long-segment anterior urethral strictures. A prospective randomized trial involved 98 patients diagnosed with anterior urethral stricture scheduled to AU between June 2022 and December 2024. Participants were randomly assigned to either the PSG or BMG arms. The comparison included patient demographics, clinicopathological characteristics of strictures, and surgical outcomes. The primary outcome was the success rate at 12 months. Secondary outcomes included functional parameters, such as the Urethral Stricture Surgery-Patient Related Outcome Measure (USS-PROM), the International Prostate Symptom Score (IPSS), the International Index of Erectile Function (IIEF) Score, the Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EJD), Q-max, and perioperative complications. The study arms were comparable regarding the preoperative parameters with a mean stricture length ± SD of 6.4 ± 2.3 and 7.9 ± 4.1 cm for PSG and BMG, respectively (p = 0.11). After a median follow-up of 20 months (12-30), the success rates of AU with PSG and BMG were comparable (93.2% v/s 97.9%, respectively; p = 0.346). There was no statistically significant difference in the IIEF (p = 0.8) and MSHQ-EJD (p = 0.22). The improvements in USS-PROM: LUTS domain (p = 0.19), USS-PROM: peeling voiding score (p = 0.62), IPSS (p = 0.43), and Q-max (p = 0.39) were comparable between the study arms. Clavien-Dindo grade I-III complications were 6.8 and 8.3% (p = 0.8), with patients' satisfaction of 90.9% and 93.8% (p = 0.5) for PSG and BMG, respectively. Kaplan-Meier survival analysis showed no statistically significant difference in stricture-free survival among both techniques (hazard ratio 1.19; p = 0.275). Our study demonstrates that PSG and BMG techniques for augmentation anterior urethroplasty have high and comparable success rates, with equal patient satisfaction and similarly low morbidity. Neither technique negatively affected sexual or ejaculatory functions.