Dorsal onlay buccal mucosal graft urethroplasty for female urethral stricture disease: A single-center retrospective study

Introduction Female urethral stricture disease (FUSD) is an uncommon but often overlooked cause of lower urinary tract symptoms in women. Many undergo repeated dilatations or urethrotomies with limited durability, leading to progressive fibrosis and delayed definitive care. Dorsal onlay buccal mucosal graft urethroplasty (BMGU) has emerged as a reliable reconstructive option. This study evaluates functional outcomes and complications following dorsal BMGU in women with FUSD.Methods A retrospective review was performed of 53 women who underwent dorsal onlay BMGU between January 2019 and July 2024 at a tertiary care center. Demographics, symptom profile, investigations, operative details, postoperative outcomes, complications and recurrence were analyzed. Uroflowmetry, postvoid residual (PVR) and International Prostate Symptom Score (IPSS) were compared before and after surgery. Mean follow-up was 30 months.Results Mean age was 47.6 ± 11.3 years, with 73.6% premenopausal. Voiding symptoms were most common and 45.3% had undergone prior dilatation or urethrotomy. Mean stricture length was 2.8 ± 0.7 cm. All procedures were completed successfully. Qmax increased while PVR and IPSS dropped significantly (all p < 0.0001). Continence was preserved in 94%. Recurrence occurred in 7.5%, mostly managed with a single dilatation. Overall complications were 18.9%, predominantly minor.Discussion/Conclusion Dorsal onlay BMGU provides significant improvement in flow, bladder emptying and symptoms, with low recurrence and minimal effect on continence. Results are valuable. This study strengthens existing evidence and highlights the importance of timely reconstruction in affected women for care.