Reconstructive urology has undergone a paradigm shift over the past 30 years with the introduction of buccal mucosal graft (BMG) for urethral reconstruction (1, 2). While short bulbar urethral strictures (under 2 cm) have traditionally been managed with excision and primary anastomosis, longer strictures are increasingly treated with BMG patch urethroplasty (3). Current studies have failed to demonstrate the superiority of one urethroplasty technique over another (4, 5). Ventral BMG urethroplasty may offer advantages in certain patient groups due to improved visualization, accessibility of the stricture, and ease of application in obese patients and patients with a short stricture segment after TUR-P (6). In this study, we aimed to review the demographic and clinical data of 64 ventral urethroplasty cases performed between 2019 and 2024 at two centers in our region.

Informed consent was obtained from all patients included in the study. We evaluated 64 patients who underwent ventral urethroplasty between 2019 and 2024, assessing preoperative and postoperative outcomes. Following a perineal incision, urethrolysis was performed to expose the stricture site. The urethra was incised proximally to the stricture, and a BMG harvested by an ENT specialist was anastomosed to the urethra at the 5, 6, and 7 o’clock positions. Sutures were placed at the 5 and 7 o’clock positions and extended distally. The spongiosum was then quilted at the 6 o’clock position to incorporate the BMG.

Data collected from patients included stricture etiology, location, and length; comorbidities; smoking status; body mass index (BMI); BMG length; postoperative donor-site complaints; preoperative endoscopic history; pre- and postoperative International Index of Erectile Function (IIEF) and uroflowmetry results; and postoperative incontinence.

The mean age of the 64 patients was 61.63 years, with an average BMI of 28.9. Etiologically, 5 cases were traumatic, 7 idiopathic, and the remaining 52 were non-traumatic (iatrogenic). Of the iatrogenic cases, 39 had a history of TUR-P.

The mean stricture length was 3.2 cm (range: 1–5 cm). Seven cases involved the anterior urethra, 56 the posterior urethra, and one had a perineal urethrostomy stricture. All patients had a history of endoscopic intervention, with an average of 4.8 (range: 1–20) prior procedures.

Mean operative time was 115.3 (75–180) minutes, with no perioperative complications. Comorbidities included diabetes mellitus (26%), hypertension (23%), and coronary artery disease (17%).

Endoscopic management had been attempted in 57 (89%) patients prior to urethroplasty. Satisfaction surveys were completed by 60 patients, with 56 (93.3%) reporting satisfaction and 4 expressing dissatisfaction due to recurrence or discomfort at the graft/perineal site.

Postoperatively, 2 (3%) patients reported donor-site discomfort, while 5 (7%) experienced perineal numbness or pain. None of the 58 sexually active patients reported erectile dysfunction. Stress urinary incontinence developed in 6 (9%) patients, 5 (7%) of whom were managed medically.

At one-year follow-up, the mean peak urinary flow rate was 23 (9.5–44) mL/s. Over a 1–5 year follow-up, recurrence was observed in only 5 patients, yielding a success rate of 92%, consistent with current literature.

The results indicate that urethroplasty is a highly effective treatment for urethral strictures, with a success rate of 92% and significant improvements in urinary function and patient satisfaction. The relatively low incidence of complications such as erectile dysfunction and the manageable levels of postoperative discomfort add to the procedure's appeal.

Ventral BMG urethroplasty is an effective and reliable option for recurrent urethral strictures, preserving anatomical integrity while minimizing tissue damage and complications. Its ventral approach enhances visualization, even in obese patients, facilitating access to proximal strictures. High functional success rates and improved quality of life further support its use. However, meticulous surgical technique and appropriate patient selection remain crucial for long-term success.

Burger RA et al (1992) The buccal mucosal graft for urethral reconstruction: a preliminary report. J Urol 147(3):662–664
Kasaby AW et al (1993) The use of buccal mucosa patch graft in the management of anterior urethral strictures. J Urol. 149(2):276–278
Wessels H, McAninch JW. Use of free grafts in urethral stricture reconstruction. J Urol 1996;155.1912-5