Female urethral stricture disease (USD) is a rare but debilitating condition that significantly impacts urinary function and quality of life. Buccal mucosal graft urethroplasty (BMGU) has emerged as an effective surgical approach for managing USD. We aim to present the interim results of an ongoing randomized controlled trial comparing two BMGU techniques—Ventral Inlay (VI) and Dorsal-Onlay (DO) and to evaluate their efficacy and safety. Our objective was to assess and compare postoperative success rate, urinary function, symptom relief, and surgical outcomes between these two techniques.

A total of 12 female patients diagnosed with USD between January 2024 and September 2024 were enrolled in this randomized controlled trial. Participants were randomly assigned to undergo either VI-BMGU or DO-BMGU. Preoperative evaluation included American Urological Association (AUA) symptom scores, urine maximum flow rate (Qmax), post-void residual urine volume (PVR) assessed ultrasonographically, and urodynamic studies. USD was confirmed intraoperatively using a 12 Fr 30° cystoscope, and the length and location of the stricture were recorded. Postoperative assessments at three months included AUA symptom scores, uroflowmetry, and PVR measurements.

The mean age of the patients was 41.4 years. VIBMGU group had 7 patients and DOBMGU group had 5 patients. The mean stricture length in both the groups was 2.5 cm. At the three-month follow-up, the median Qmax was 20 ml/sec in VIBMGU group and 21 ml/sec in DOBMGU group(p<0.05). Similarly, both the groups demonstrated significant improvements in AUA symptom scores and PVR reduction, with no notable difference in outcomes. Success rates were 100% in both the groups, respectively. No patients experienced recurrence during the follow-up period. Compared to DO-BMGU, VI-BMGU demonstrated additional advantages, including shorter operative time, reduced intraoperative blood loss, and decreased postoperative pain. Furthermore, VI-BMGU was a vaginal-sparing technique, which may offer additional benefits in terms of preserving vaginal integrity and reducing postoperative morbidity.

The findings of this study indicate that both VI-BMGU and DO-BMGU provide significant improvements in reduction in postoperative AUA scores and PVR, increase in Qmax for female patients with USD.

Both VI-BMGU and DO-BMGU are effective surgical techniques for female USD, yielding comparable improvements in urinary function and symptom relief. However, VI-BMGU offers the added benefits of a simpler surgical approach, reduced operative time, lesser blood loss, and less postoperative discomfort while preserving vaginal integrity. Given these advantages, VI-BMGU may be a preferable technique for managing female USD, particularly in patients who require a less invasive and faster recovery approach.