Early Outcomes of Dorsal Onlay Buccal Mucosal Graft Urethroplasty for Female Urethral Stricture Disease: A Single-Center Experience

Background and Objectives: To evaluate the surgical, functional, and perioperative outcomes of Dorsal Onlay Buccal Mucosal Graft Urethroplasty (DO-BMGU) in women with Female urethral stricture (FUS) disease. Material and Methods: A retrospective analysis was performed including women who underwent DO-BMGU for FUS at a single tertiary referral center between January 2018 and October 2025. The primary outcome was freedom from reintervention for symptomatic recurrence. Secondary outcomes included perioperative outcomes, complications, and changes in maximum urinary flow rate (Qmax) and postvoid residual urine volume (PVR). Results: Twenty women with a mean age of 52.9 ± 14.7 years were included. The median stricture length was 2 cm (IQR 2–3), and all patients had undergone previous urethral dilatation. Median operative time was 65 min (IQR 60–80), with a median hospital stay of 3 days (IQR 3–4). During a median follow-up of 12 months (IQR 12–24), 18 patients (90%) remained free from reintervention for symptomatic recurrence. Two patients developed recurrent symptomatic narrowing and were successfully managed with urethral dilatation. At the 3-month objective functional assessment, mean Qmax improved significantly from 6.1 ± 2.3 to 20.4 ± 5.8 mL/s (p < 0.001), while median PVR decreased from 125 mL (IQR 94.5–155) to 10 mL (IQR 10–40) (p < 0.001). No patient experienced major bleeding or urethrovaginal fistula. One patient (5%) developed mild de novo stress urinary incontinence, and postoperative complications were generally minor and managed conservatively. Conclusions: DO-BMGU was associated with favorable early objective functional outcomes and a high rate of freedom from reintervention for symptomatic recurrence, with few clinically significant complications in this small cohort. Larger prospective studies with longer follow-up are warranted to confirm the long-term durability of this technique.