Urethroplasty for female urethral stricture (FUS) is becoming an increasingly popular treatment option. Urethral dilation of female urethtral stricture has high recurrence rate, particularly following an initial unsuccessful trial of dilation. However, there is little to guide choice of urethroplasty technique as all series to date are small with limited follow-up. We report the medium to long-term outcomes of ventral onlay buccal mucosa graft substitution urethroplasty (VOBMGSU) in treating FUS.

A retrospective review was undertaken of a prospectively acquired database of 46 consecutive women of median age 51.5 years (range 31-71) with FUS having VOBMGSU since June 2012. Follow up was a minimum of 6 months (median 25 months, range 6-96 months). Data was reviewed for recurrence of stricture, median peak free flow rate (Qmax), median post-void residuals (PVR) and Patient Global Impression of Improvement score (PGII) using a 7-point Likert scale (where 1 = very much better and 7 = very much worse). Short and longer-term complications of surgery were also recorded. Persistent or de-novo lower urinary tract symptoms (LUTS) were investigated to determine their cause.
Statistical analysis was performed with the Wilcoxon signed rank test, Students T Test and Mann-Whitney U Test. Statistical significance was taken as P<0.05.

At last follow-up 42/46 (91.3%) women were stricture free. Mean Qmax significantly improved from 5.7 ml/s (range 0-13) to 15.5 ml/s (range 4- 38) (p < 0.05). Mean PVR significantly reduced from 147mls (range 0-609) to 24 mls (range 0-245) (p < 0.05). Short and longer-term complication rates were low. 4 patients had pre-existing stress urinary incontinence (SUI). 2/42 (4.7%) patients developed mild de novo SUI, which settled with conservative measures by 6 months post urethroplasty. Frequency persisted in 4/46
(8.7%) and was managed with intravesical Botox in 2 and Sacral Neuromodulation in 1.

Stricture recurrence was managed by meatotomy in 1, meatal dilatation in 1 and redoVOBMGS urethroplasty in 1 with resolution of stricture. A further patient had their recurrent stricture managed with redo VOBMGSU but suffered a further recurrence which was
managed with a meatotomy. Median PGII at 12 months post VOBMG urethroplasty was 1.5 (range 1-4) and this was maintained at 36 months post-surgery

VOBMG for the treatment of female urethral stricture offers excellent medium term stricture rates of over 91%. Patient satisfaction is high and complication rates are low. Statistically significant improvements are seen in flow rates and post void residuals. De-novo SUI is was at 4.7% and settled with conservative management.

Medium to long term results in the largest series of VOBMG female urethroplasty to date are excellent with stricture free rates of 91.3%, median PGII of 1.5 and significantly improved Qmax and PVRs.