İntroduction 
We aimed to present the surgical details and outcomes of our ‘AZ’ technique for ventral onlay buccal mucosa graft (BMG) urethroplasty in female patients with urethral strictures.

Methods: 
40 female patients who underwent BMG urethroplasty using the ‘AZ’ technique between January 2015 and December 2025 and were followed up for at least 3 months were retrospectively analyzed. The patients’ age, cause of stricture, stricture length, comorbidities, number of prior treatments, pre- and postoperative uroflowmetry data, post-void residual urine volume, complications, and recurrence status were recorded. The postoperative Qmax value was assessed approximately three months after surgery. Patients without postoperative uroflowmetry data were evaluated clinically. Success was defined as the absence of stricture recurrence.

Results:
The mean age of the patients was 51.5 ± 13.0 years (range 31–80). The mean stricture length was 2.4 ± 0.8 cm, and the mean BMS length was 3.1 ± 0.7 cm. Eighty percent of the strictures were located in the midurethra. The most common etiology was idiopathic (67.5%), followed by iatrogenic/obstetric causes (22.5%). All patients had a history of previous dilation; 60% had undergone more than three dilations. The mean preoperative Qmax was 6.6 ± 2.6 mL/s, and this value improved significantly to 26.7 ± 8.2 mL/s in the postoperative period. Continence was preserved in 38 patients (95%); two patients reported urge incontinence, and one of these had also experienced urge incontinence in the preoperative period. Swelling was observed in the donor site in 1 patient (2.5%), and this was treated conservatively. Recurrence of stricture was observed in 3 patients (7.5%); in 2 of the 3 patients with recurrence, the BMG ‘AZ’ technique was reapplied after they did not benefit from dilation. The other patient with recurrence was treated with dilation. The overall success rate was 97.5% during a mean follow-up period of 37.7 months (range 3–90 months).

Conclusion:  
The ‘AZ’ technique for ventral onlay BMG urethroplasty achieves a high success rate in cases of female urethral stricture and offers an effective treatment option, particularly in recurrent cases.

The long-term outcomes of the ventral urethroplasty ‘AZ’ technique have demonstrated that it can be used as an alternative to current techniques due to its ease of application and the preservation of the sphincter. In all patients, postoperative Qmax increased significantly, PVR decreased significantly, and no serious complications were observed.

Continence 19S (2026) 102786
DOI: 10.1016/j.cont.2026.102786