Direct vision internal urethrotomy for short bulbar urethral strictures is associated with high recurrence rates, whereas urethroplasty, although effective, is associated with higher morbidity. Autologous live cultured buccal epithelial cell implantation represents a novel regenerative approach aimed at improving outcomes following endoscopic management. This study aims to evaluate the efficacy and safety of autologous live cultured buccal epithelial cell implantation following direct vision internal urethrotomy in patients with bulbar urethral strictures.

This was a single-center prospective study conducted between May 2023 and May 2025 at a tertiary care institution. Adult male patients aged 18 to 65 years with bulbar urethral strictures measuring 1 to 4 cm were included. Buccal mucosa was harvested and processed under good manufacturing practice conditions to obtain cultured epithelial cells. Following direct vision internal urethrotomy, these cells were re-implanted endoscopically at the stricture site. Patients were followed up at regular intervals up to 24 months. The primary endpoint was defined as treatment success, which included an American Urological Association symptom score less than 7, maximum urinary flow rate greater than 12 mL per second, and post-void residual urine less than 100 mL. Clinical outcomes, functional parameters, and complications were recorded.

A total of 30 patients were included in the study. The median age was 33.5 years and the median stricture length was 1.5 cm. The median follow up duration was 18 months. Significant improvements were observed in all functional parameters. The maximum urinary flow rate increased from 4.85 mL per second preoperatively to 18.25 mL per second postoperatively. Post void residual urine decreased from 121 mL to 37 mL. The median symptom score improved from 27 to 3.5. The success rates were 73.3 percent at 6 months, 70 percent at 12 months, 63.3 percent at 18 months, and 53.3 percent at 24 months. Recurrence occurred in 23.3 percent of patients, predominantly within the first 12 months. Two patients developed transient sepsis, which was managed conservatively. No donor site morbidity or sexual dysfunction was observed.

Autologous live cultured buccal epithelial cell implantation following direct vision internal urethrotomy demonstrates significant improvement in functional outcomes with an acceptable safety profile. The progressive decline in success rates over time suggests that while this technique may delay recurrence, long-term durability requires further evaluation. The early recurrence pattern indicates the need for careful follow-up, particularly within the first year.

Autologous live cultured buccal epithelial cell implantation is a promising minimally invasive regenerative technique that may enhance the outcomes of endoscopic management for short bulbar urethral strictures. This approach offers a balance between efficacy and reduced morbidity. Larger randomized controlled studies with longer follow-up are required to establish its definitive role in clinical practice.

Continence 19S (2026) 102560
DOI: 10.1016/j.cont.2026.102560