Staged Buried Oral Mucosal Strip Urethroplasty for Long-Segment Post-Hypospadias Urethral Strictures: Achieving Functional Recovery and Distal Meatal Preservation.

PURPOSE: Long-segment urethral strictures following hypospadias repair (LUSPH) represent a formidable reconstructive challenge. Few techniques simultaneously achieve durable stricture resolution while preserving the distal urethral meatus. This study evaluates the efficacy, safety, and patient-reported outcomes of staged buried oral mucosal strip urethroplasty for LUSPH. PATIENTS AND METHODS: A retrospective analysis was conducted on patients undergoing this procedure between June 2016 and June 2024. Stage one involved inlay of an oral mucosal graft. In the second stage, the healed composite mucosal strip was tubularized using penile fascial flap. Outcomes assessed included maximum flow rate (Qmax), patient-reported outcome measures (USS-PROM, QoL-PROM, IIEF-5), surgical success (defined as unobstructed voiding without intervention, Qmax >15 mL/s, and absence of major complications), and complications. RESULTS: Sixty-one patients were enrolled, with a mean age of 29.8 ± 9.1 years and mean stricture length of 4.7 ± 0.7 cm. Ultimately, 51 patients (83.6%) achieved unobstructed voiding meeting the definition of surgical success. The mean Qmax at 1-year postoperatively was 18.5 ± 4.3 mL/s. From preoperatively to 1-year postoperatively, USS-PROM scores significantly decreased from 21.0 ± 2.0 to 6.6 ± 2.2 (P < 0.001), while QoL-PROM scores significantly improved from 46.6 ± 6.7 to 87.2 ± 8.2 (P < 0.001). IIEF-5 scores showed no significant change. Finally, 54 patients (88.5%) maintained a meatus positioned above the coronal sulcus. CONCLUSIONS: In this single-center retrospective cohort, staged buried oral mucosal strip urethroplasty demonstrated favorable mid-term efficacy and safety for LUSPH.