The incidence of FUS is reported to be low (0.1-1%) and 4-10% among females with bladder outlet obstruction. However, the true incidence of FUS is still unknown. The lack of uniform criteria for diagnosing FUS poses a major challenge for urologists worldwide. The lack of uniform criteria for diagnosing FUS poses a major challenge for urologists worldwide. The first description of vaginal flap urethroplasty was by Hariss in 1935. It took a long time for urologists to acknowledge female urethral reconstructive procedures due to their difficulty and imminent threat to functional and sexual complications. Urethral dilatation has remained the first and most frequent treatment method for female urethral stricture. Recently, dorsal onlay buccal mucosal graft urethroplasty has become a popular and preferred choice of urethral stricture repair. Another surgical repair, Ventral inlay buccal mucosal graft urethroplasty, has also shown promising outcomes in limited series. The main advantage of the Ventral inlay buccal mucosal graft urethroplasty technique over dorsal onlay buccal mucosal graft urethroplasty is preserving the neurovascular bundle . However, there has yet to be a study published to date comparing these techniques. In our study, we aim to compare Ventral inlay buccal mucosal graft urethroplasty with dorsal onlay buccal mucosal graft urethroplasty for the treatment of female urethral stricture.

Between Sept 2019 and May 2023, 40 women with USD were randomized to undergo either Ventral inlay buccal mucosal graft urethroplasty or dorsal onlay buccal mucosal graft urethroplasty. All were evaluated preoperatively with American Urological Association (AUA) symptom score, Uroflowmetry, and Post-void residual (PVRU) urine. Intraoperatively, USD was confirmed with a 6 Fr 30o cystoscope, length and location of stricture, blood loss and duration of    surgery were noted. Postoperative evaluation included, visual analogue score (VAS), need for analgesia, follow-up after surgery with AUA symptom score, Uroflowmetry, and PVRU

The mean age was 45 years and mean   follow‑up was 12 months. The mean    stricture length in both groups was 1.8 cm. Twenty -four patients underwent Ventral inlay buccal mucosal graft urethroplasty while 16 underwent Dorsal onlay buccal mucosal graft urethroplasty.  The median duration of surgery ( 28.5 [22-38] m VS  44.50 [39.25-52.75]m) and  median blood loss (7.50  [5-10] ml  VS  15(11.25-20) ml, was statistically significant for Ventral inlay buccal mucosal graft urethroplasty -Group as compared to dorsal onlay buccal mucosal graft urethroplasty -Group (p<0.05). 
The median VAS scores at 6 hours after surgery were significantly lower for the Ventral inlay buccal mucosal graft urethroplasty group [5.50(5-6)] than the dorsal onlay buccal mucosal graft urethroplasty group [7(6- 7.75)] (p<0.05)  but at 24 hours. The Ventral inlay buccal mucosal graft urethroplasty group required less analgesia. All women voided successfully after catheter removal..  There was no statistically significant difference in improvement in AUA score and Qmax and reduction in PVR at 3, 6, and 12 months between both groups. One patient in each group had failure  on 1yr- follow-up, giving as success rates of  96% and 93% respectively

This was a randomized trail comparing result of Ventral inlay buccal mucosal urethroplasty and dorsal onlay mucosal urethroplasty showed that the ventral inlay technique was associated with shorter surgery duration and less blood loss compared to the dorsal onlay technique. The ventral inlay group also reported lower pain scores at 6 hours post-surgery and required less analgesia. Both groups had successful voiding after catheter removal, and there were no significant differences in improvement in AUA score, maximum flow rate (Qmax), and reduction in post-void residual urine (PVR) at 3, 6, and 12 months.

The success rates of the two techniques were high, with 96% success in the ventral inlay group and 93% success in the dorsal onlay group at 1-year follow-up. However, there was no statistically significant difference in success rates between the two groups.

Ventral inlay buccal mucosal graft urethroplasty is a simple and safe method of urethroplasty in women. The Ventral inlay buccal mucosal graft urethroplasty has similar outcomes as dorsal onlay buccal mucosal graft urethroplasty with the additional advantage of lesser operative time, lesser blood loss and less pain.

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West C, Lawrence A. Female urethroplasty: contemporary thinking. World J Urol. 2019;37(4):619-629. doi:10.1007/s00345-018-2564-4
Nayak P, Mandal S, Das M. Ventral-inlay buccal mucosal graft urethroplasty for female urethral stricture. Indian J Urol. 2019;35(4):273-277. doi:10.4103/iju.IJU_57_19

Continence 12S (2024) 101601
DOI: 10.1016/j.cont.2024.101601