Bladder outlet obstruction (BOO) is relatively uncommon cause of lower urinary tract symptoms (LUTS) in women. It has been estimated that BOO accounts for between 2.7–8% of women with LUTS. In those women with known BOO, female urethral stricture (FUS) account for between 4–18% of these cases. Symptoms of FUS may be variable, but often include hesitancy, poor flow, frequency, urgency, dysuria, and may lead to recurrent urinary tract infection and overt urinary retention. 
 The causes of FUS may include trauma, iatrogenic injury, infection, malignancy, and radiation. 
 There is currently no widely accepted definition for FUS. It has been described as a fixed anatomical narrowing between the bladder neck and distal urethra (<14 Fr), of inadequate caliber to allow catheterization.
Several reconstructive techniques for the management of more extensive FUS have been described to date. These have included vaginal or labial flaps, as well as vaginal and oral mucosal grafts. Specifically, the dorsal approach refers to the 12 o’clock position, while ventral refers to the 6 o’clock position.
Potential benefits of the dorsal approach would include the avoidance of a vaginal incision and its associated post-operative complications, including issues with urethro-vaginal fistula and wound complications. There are several potential advantages of the ventral approach to reconstruction of FUS. Avoidance of dorsal urethral dissection would avoid neurovascular structures of the clitoris, which could potentially minimize the risk of post-operative sexual dysfunction. It would also avoid division of the pubo-urethral ligaments, and incision of the urethral sphincter at its dorsal aspect, theoretically reducing the risk of urinary incontinence.
The aim of this study to show results of our new  new ventral buccal musosal graft urehtroplasty,Pamukkale AZ technique, for  female urethral stricture reconstruction.

We included 5 female patients who had buccal mucosal graft urethroplasty which was described by us, between January 2015 and November 2018 and had at least 6 months follow-up.
Surgical Technique
In extended lithotomy position, nasal intubation is performed and usually 2 teams are preferred to work simultaneously at the donor and recipient sites, when available, to decrease total operation time. Oral mucosa is harvested with the help of a mouth retractor. Lidocaine and epinephrine (1:100.000) solution is injected beneath the mucosa to facilitate dissection and to decrease bleeding and postoperative pain. A 4 cm long and 2 cm wide oral mucosa is harvested. Before starting the recipient site, urethroscopy is performed with a 4.5F pediatric ureteroscope. An inverted U-shaped incision is made on the anterior vaginal wall, starting from the bladder neck extending to the urethral meatus and flap is dissected with the help of 2 retraction sutures. Urethra is dissected through the bladder neck and incised ventrally to expose the whole stricture longitudinally. Then, buccal mucosal graft is quilted to the vaginal flap with multiple 5/0 polyglactin sutures, after submucosal fat is removed meticulously. Buccal mucosatached vaginal flap is attached to the urethral incision and anastomosed (mucosa to urethra and vagina to vagina) with continuous 5/0 polyglactin sutures bilaterally. A 14F silicone Foley catheter is inserted and left for 3 weeks.

Patient age, stricture lenght, comorbidities, previous treatments, preoperative and postoperative maximal flow rates was shown in the table.

Patient age, stricture lenght, comorbidities, previous treatments, preoperative and postoperative maximal flow rates was shown in the table.

While urethral dilation is an appropriate initial management step, urethral reconstruction should be considered as a definitive surgical option in those refractory to one dilatation. While the various techniques reported in case series to date have all demonstrated excellent success rates, the best approach has yet to be elucidated. Overall, an individualized approach based on patient factors, stricture characteristics, and surgeon experience is most appropriate. 
Our new ‘Pamukkale AZ ‘ ventral female urehtroplasty tecnique  is feasibe, provides better supporting tissue  for mucosal viability and reduces incontinence risk.

Sharma GK, Pandey A, Bansal H, et al. Dorsal onlay lingual mucosal graft urethroplasty for urethral stricture in women. BJU Int 2010;105:1309-12.
Goel A, Paul S, Dalela D, et al. Dorsal onlay buccal mucosal graft urethroplasty in female urethral stricture disease: a single-center experience. Int Urogynecol J 2014;25:525-30.
Gormley EA. Vaginal flap urethroplasty for female urethral stricture disease. Neurourol Urodyn 2010;29 Suppl 1:S42-5.