To evaluate  the results of using  buccal mucosal graft 
augmentation urethroplasty in dorsolateral approach in patients with long- segment anterior 
urethral strictures.

This prospective study included 50 patients with anterior urethral strictures. Inclusion criteria were: non traumatic non-obliterative anterior urethral strictures more than 2 cms long who were scheduled for (BMG) urethroplasty.  
Exclusion criteria included patients with oral pathology, patients who are unfit for surgery ± anesthesia, patients with preoperative erectile dysfunction, bleeding tendency ± coagulopathy, pediatric age group, other bladder and /or urethral pathologies (ex urethral stone, bladder mass), and history of previous urethroplasty.
All patients were subjected to: clinical history taking including IPSS, QOL & IIEF score erectile function domain (Q1, 2, 3, 4, 5, 15), clinical examination, urine analysis and culture, uroflowmetry, PVR by Pelvi-abdominal U/S, retrograde Urethrography, and
sono-urethrography to detect the extent of spongiofibrosis.
Patients were followed for a minimum of one year after urethroplasty (3, 6 and 12 months). Both urethroplasty and sexual outcomes were evaluated.

The mean age of the patients was 40.16±13.55 years. Mean length of the urethral stricture was 6.53±0.69. Mean duration of operation was 142.0±6.61 minutes. The mean Qmax pre operative was 6.64±1.79, and the mean Qmax at 3m, 6m, and 1y post operative was 21.4±2.19, 20.12±2.33, 19.08±2.12. The mean IPSS score pre operative was 26.84±2.01, and the mean IPSS score at 3m, 6m, and 1y post operative was 4.04±1.01, 5.04±1.23, 4.29±1.19.The mean IIEF score pre operative was 28.32±1.6, and the mean IIEF score at 3m, 6m, and 1y post operative was 26.16±1.67, 27.88±1.76, 27.5±1.12. Three patients developed recurrent urethral stricture which was corrected by VIU and included in the dilatation program. Three patients had wound infection that was managed conservatively. In univariate analysis for predictors of complication; stricture length, co-morbidities and positive urine culture were significant predictors for complication. Multivariate Logistic Regression for detection of independent predictors of complication showed that Co-morbidities was the only significant independent predictor.

The mean age of the patients was 40 years old mostly sexually active. The mean operative time was alittle bit long as we had two teams working together, the graft team didn't work untill the ureteroplasty team identify the accurate stricture length.
There was a significant improvement in both urethroplasty and sexual outcomes with no significant complications.

Dorsolateral buccal mucosal augmentation urethroplasty is a surgical option that can be used in the treatment of long segment anterior urethral strictures with high success and low complication rates.