Outcomes of Redo Dorsal Onlay Buccal Mucosal Graft Urethroplasty After Failed Ventral Urethroplasty in Women.

introduction and hypothesisTo present the outcomes of dorsal onlay (DO) BMG urethroplasty cases after primary urethroplasty failure.

methodsA total of 45 patients who had BMG urethroplasty were retrospectively reviewed. Nine patients who had unsuccessful primary urethroplasty and underwent redo dorsal onlay BMG urethroplasty were identified. Failure was defined as a Qmax of less 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.

resultsThe 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. The median follow-up duration was 18 months. The success rate was 77.8% over a median follow-up period of 18 months.

conclusionsThe 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 which shows high success and low complication rates, are encouraging; however, more studies with larger patient populations are needed to validate its efficacy in the treatment of recurrent FUS.