Managing urethral strictures is complex, requiring various surgical approaches such as direct visual internal urethrotomy (DVIU) and different forms of urethroplasty utilizing grafts or flaps. Buccal mucosal graft (BMG) urethroplasty has become a preferred technique for reconstructing anterior urethral strictures, particularly in cases requiring extensive tissue replacement.
The purpose of this research was to evaluate the effectiveness and functional outcomes of BMG urethroplasty in patients suffering from anterior urethral strictures.

This study employed a descriptive cross-sectional design and was conducted at Sharg Alneel and Alkwaty hospitals. The research included patients diagnosed with anterior urethral strictures at Sharg Alneel Hospital Urology Center from 2014 to 2021. Data were gathered using a structured checklist and processed using SPSS software (version 24) for analysis.

A total of 71 patients were included in this study, with an age distribution as follows: 38 individuals (53.5%) were aged 20–40 years, while 33 patients (46.5%) were above 40 years old. The majority (71.8%) were married.

Surgical Duration: In 90.1% of cases, the surgery exceeded two hours.

Causes of Stricture:

Infection-related cases: 63.4% (45 patients)

Iatrogenic (instrumentation-related): 9.9% (7 patients)

Trauma-related cases: 9.9% (7 patients)

Balanitis xerotica obliterans (BXO): 9.9% (7 patients)

Unknown cause (idiopathic): 7% (5 patients)


Stricture Length Distribution:

3–4 cm: 49.3% (35 cases)

More than 4 cm: 49.3% (35 cases)


Stricture Location:

Bulbopenile urethra: 43.7% (31 cases)

Bulbar urethra: 35.2% (25 cases)

Panurethral strictures: 18.3% (13 cases)

Penile urethra: 2.8% (2 cases)


Surgical Techniques Used:

Russell urethroplasty: 49.3% (35 cases)

Augmentation urethroplasty: 28.2% (20 cases)


Overall Success Rate: 91.5%


Postoperative Donor Site Complications

Among the patients, 30 individuals (42.3%) reported donor site complications, with the most frequently observed issues being:

Postoperative pain: 32.4% (23 cases)

Tissue swelling: 5.6% (4 cases)

Contracture formation: 4.2% (3 cases)

Sensory loss: 1.4% (1 case)

1. Surgical Success and Graft Performance

Russell urethroplasty (49.3%) was the most commonly performed technique, likely due to its versatility and effectiveness in managing long-segment urethral strictures.

The success rate of 91.5% aligns with global findings, confirming that BMG is a gold-standard tissue substitute for anterior urethral strictures. Its tough, elastic, and durable nature allows for effective reconstruction with minimal risk of recurrence.

The surgical duration exceeded two hours in 90.1% of cases, reflecting the technically demanding nature of urethroplasty procedures, especially in patients with long-segment strictures.


2. Postoperative Donor Site Complications

42.3% of patients experienced donor site morbidity, with the most frequent complaints being pain (32.4%), followed by swelling (5.6%), contracture formation (4.2%), and loss of sensation (1.4%).

These findings indicate that while BMG is effective, it is not entirely without drawbacks, particularly in terms of oral discomfort and functional issues following graft harvest.

However, the absence of severe complications, such as infection or graft failure, supports the idea that BMG remains a safe and well-tolerated option for urethral reconstruction.



Conclusion

The study reinforces that BMG urethroplasty is a highly effective and safe technique, particularly for long-segment anterior urethral strictures. While donor site complications are relatively common, they are generally minor and manageable, making BMG a preferred choice for urethral reconstruction. Moving forward, efforts should focus on improving early disease detection, optimizing surgical techniques, and enhancing post-operative care to further improve outcomes.

Due to its durability, elasticity, and straightforward harvesting technique, the buccal mucosal graft is a highly effective tissue substitute for patients with long anterior urethral strictures. Since it provides excellent functional outcomes without external scarring, BMG urethroplasty should be prioritized as the primary treatment option for extensive urethral strictures.