Female urethral stricture (FUS) is a rare, and largely underdiagnosed condition. 
The most widely accepted definition of female urethral stricture is a symptomatic, anatomical narrowing of the urethra based on a failure of catheterization, urethral calibration, visual inspection, endoscopy or radiography.
Urethral dilation and vaginal flap urethroplasty have been the most commonly described treatments.
The aim of this study was to describe the technique and assess the outcomes of dorsal onlay oral mucosa urethroplasty for female urethral stricture.

Objective: To assess the outcomes of dorsal onlay oral mucosa graft urethroplasty for FUS.
Design of the study: We retrospectively reviewed the charts of all female patients who underwent dorsal onlay oral (buccal or lingual) mucosa urethroplasty for urethral stricture between 2011 and 2020 at two academic institutions.  The exclusion criteria were patients under 18-year-old, male patients or urethroplasty performed for other indications than urethral stricture (e.g. sling erosion). 
Surgical procedure: Four surgeons performed the urethroplasties using a standardized technique: suprameatal incision, dissection and longitudinal opening of the dorsal aspect of the urethra, harvest of the oral mucosa graft, graft onlay sutured into the urethral opening.
Measurements: The primary endpoint was clinical success defined as any subjective improvement in LUTS self-assessed by the patients 1 to 3 months after catheter removal.

Nineteen patients were included over the study period. The mean operative time was 126.6 minutes and the median length of hospital stay was one day (range:0-3). There were two postoperative complications both of which were minor (1 UTI and 1 sinusitis, Clavien grade 2). The clinical success rate was 94.7% at 1 to 3 months and 90.9 % at 1 year. After a median follow-up of 12 months (range 1-49) there was one recurrence (5.3%), clinical success was achieved in 17 patients (89.5%) and both the maximum urinary flow rate and post void residual were significantly improved (15.2 vs. 7.4 ml/s preoperatively; p=0.008 and 71.5 vs. 161.1 ml preoperatively; p=0.001 respectively). The de novo stress urinary incontinence rate was 15.7 % at 1 to 3 months and 9.1% at 1 year.

Dorsal onlay oral mucosa graft urethroplasty for female urethral stricture appears feasible across multiple surgeons and is associated with a low perioperative morbidity, satisfactory functional outcomes and a low recurrence rate. Other series with larger sample size and longer follow-up are needed to confirm these findings.

Repairing narrowed urethra with dorsal onlay oral mucosa graft in women appears feasible, safe and reproducible.