Surgical technique for female dorsal buccal mucosa graft urethroplasty

Introduction: Female urethral stricture (FUS) is a rare and frequently underdiagnosed cause of bladder outlet obstruction (BOO) in women, implicated in approximately 1% of cases presenting with lower urinary tract symptoms (LUTS). Diagnosis is challenging due to its rarity and the lack of standardized criteria, thus treatment decision are also complex. Methods: The case is a 25-year-old woman with persistent LUTS unresponsive to conservative management. Uroflowmetry, urethroscopy, and urodynamics, confirmed a mid-urethral stricture. She underwent dorsal buccal mucosa graft urethroplasty. Under general anesthesia and lithotomy positioning, a buccal graft was harvested and parachuted into place via a dorsal urethrotomy. A 16 Fr Foley catheter was maintained for 10 days. Results: Operative time was 100 min with minimal blood loss. Postoperative recovery was uneventful, with resolution of symptoms, continent and normalization of voiding function (Qmax: 22 mL/s) at 3-month follow-up. Donor site healing was satisfactory, and had no sexual dysfunction. Conclusion: Conservative approaches like urethral dilatation (UD) show limited long-term success, particularly after repeated interventions. Augmentation urethroplasty offer superior outcomes with success rates approaching 90%. Buccal mucosa grafts (BMG) are the most frequent graft reported. While both dorsal and ventral approaches are used, the dorsal route may better preserve urethral support and future surgical options. Our experience and prior series support the dorsal BMG approach as a reliable technique, demonstrating durable results with minimal complications.