To present the outcomes of dorsal onlay(DO) BMG-urethroplasty cases after primary ventral-BMG-urethroplasty failure in woman with urethral stricture.

To our knowledge, this is the first study to investigate the results of recurrent BMG urethroplasty after the failure of primary urethroplasty in FUS treatment. A total of 45 patients who had BMG urethroplasty were retrospectively reviewed. Nine patients who had unsuccessful primary ventral urethroplasty and underwent re-do dorsal onlay BMG urethroplasty were identified. We consider the 12 o'clock position as dorsal and the 6 o'clock position as ventral. Failure was defined as a Qmax of lower than 12 ml/s in a symptomatic patient, an inability to calibrate with an 12 Fr catheter, or the necessity for any intervention, including dilation during the follow-up period.

The median age was 56 years. All patients presented with a history of urethral dilatation and urethroplasty. The baseline median maximum urinary flow rate(Qmax) was 6.5 mL/s, and the median post-void residual(PVR) was 55 mL. The majority of strictures were located in the distal urethra, with stricture lengths ranging from 1.5 to 3 cm. Postoperative functional outcomes demonstrated a significant improvement, with a median postoperative Qmax of 26 mL/s(p=0.006) and a median PVR of 27 mL(p=0.043). None of the patients experienced de-novo stress urinary incontinence following DO-BMG urethroplasty. No patient experienced bleeding requiring transfusion. No patients developed wound infections or urinary tract infections. With the exception of one patient who experienced donor site pain necessitating oral analgesics, no problems associated with the donor site were noted. The median follow-up duration was 18 months. The success rate was 77.8% over a median follow-up period of 18 months.

The dorsal approach offers advantages such as enhanced vascularity attributed to the clitoral neurovascular bed on this side and the preservation of the vaginal ventral bed for future interventions such as midurethral slings. Conversely, potential risks encompass bleeding attributed to vascularity and de-novo stress incontinence due to the sphincter damage. Nonetheless, these risks are less common than anticipated.  Given the close proximity of clitoral neurovascular structures, impairment of sexual function is theoretically possible in dorsal urethroplasty techniques. The 78% success rate shown by this study demonstrates the efficacy of this approach. On the other hand, the absence of major complications such as urinary incontinence and bleeding indicates that this method can be safe. 

Our study has certain limitations, including its retrospective design and the limited sample size. The study's statistical efficacy may be compromised by the limited sample size, necessitating careful consideration during result interpretation. Female urethral stricture is a relatively uncommon problem, making it challenging to achieve substantial patient numbers from a single center.  The absence of a control group can also be mentioned as another limitation. Additionally, the relatively short median follow-up period of 18 months may be considered insufficient for monitoring late recurrences, and this could be considered a limitation of the study. Therefore, the results of the current study should be interpreted with caution.

The preliminary results from dorsal onlay BMG urethroplasty procedures conducted on patients with recurrence following ventral urethroplasty indicate high success rates and very low complication rates. The dorsal onlay BMG urethroplasty can be a feasible option in selected cases who have previously had ventral urethroplasty and experienced recurrence. The results of this study are encouraging; however, the findings of this retrospective, descriptive study, particularly with its limited number of patients, should be interpreted with caution. More prospective studies with a larger patient population and extended follow-up durations are necessary to validate its efficacy in the treatment of recurrent FUS post-urethroplasty.

Continence 19S (2026) 102782
DOI: 10.1016/j.cont.2026.102782