Buccal mucosal graft urethroplasty and Martius flap for female urethral stricture

• Female urethral stricture often has high recurrence rates when managed endoscopically • Buccal mucosal graft urethroplasty with Martius flap provides good definitive management for urethral stricture with minimal adverse outcomes and morbidity Female urethral strictures are an underdiagnosed cause of lower urinary tract symptoms. They are commonly treated endoscopically but this can be associated with high recurrences. 1,2 Urethroplasty is the definitive form of treatment with good long-term outcomes. In this video, we describe buccal mucosal graft urethroplasty and Martius flap for the treatment of recurrent female urethral stricture. Ventral buccal mucosal graft (BMG) urethroplasty does not require dorsal dissection, thereby mitigating the risk of postoperative sexual dysfunction and stress urinary incontinence. 3-5 Interposition of a Martius flap provides a healthy vascular base for the graft, prevents urethrovaginal fistula and facilitates potential future surgery for treatment of stress urinary incontinence. 6,7 Our patient is a 51-year-old female who presented with acute retention of urine due to recurrent urethral stricture. She had multiple failed prior dilatations, reported difficult self-catheterisation post-dilatations, and was found to have chronic false passages on cystoscopy. She elected to pursue buccal mucosal graft urethroplasty. After informed consent, video recording of the intraoperative surgical procedure was performed, and the key steps of the procedure are highlighted. She recovered well postoperatively with no symptom recurrence or de novo stress urinary incontinence, She remains unobstructed at one-year follow-up. We have since performed this surgery for another patient with female urethral stricture with good outcomes at the latest 3-month postoperative review. BMG urethroplasty with Martius flap is an effective definitive treatment for female urethral stricture with good surgical outcomes and minimal morbidity.