Comparative outcomes of buccal mucosa graft versus inner preputial flap substitution urethroplasty for long-segment anterior urethral stricture: A retrospective cohort study

Introduction: Long bulbar urethral strictures not amenable to excision and primary anastomosis are best managed with substitution urethroplasty. Buccal mucosa grafts (BMGs) and inner preputial flaps (IPFs) are the most established options, each with advantages and limitations. Materials and Methods: = 40). Preoperative evaluation included retrograde urethrography, uroflowmetry (Qmax), postvoid residual volume, and questionnaires (International Prostate Symptom Score [IPSS]; International Index of Erectile Function-5). Surgical success was defined as Qmax ≥15 mL/s, IPSS <8, and no obstructive symptoms or re-intervention. Patients were followed at 6 and 12 months. Stricture-free survival was analyzed using Kaplan-Meier estimates. Results: = 0.12). Complication rates were low and comparable between groups, with no Clavien-Dindo grade ≥ III events. Conclusion: Both BMG and IPF urethroplasty achieve excellent 1-year outcomes. BMG shows a trend toward greater durability and technical simplicity, whereas IPF remains a valuable option when oral harvest is contraindicated.