Dorsal Onlay Labial Mucosal Graft Urethroplasty in Female Urethral Stricture: Outcomes of Over 200 Cases From a Single Surgeon

Ajit Kumar Jena; Rahul Jena; Manupirya Madhavan; Kumar Madhavan

doi:10.1016/j.urology.2025.05.040

Dorsal Onlay Labial Mucosal Graft Urethroplasty in Female Urethral Stricture: Outcomes of Over 200 Cases From a Single Surgeon

Urology. 2025 May 23:S0090-4295(25)00499-6. doi: 10.1016/j.urology.2025.05.040. Online ahead of print.

Authors

Ajit Kumar Jena¹, Rahul Jena², Manupirya Madhavan³, Kumar Madhavan⁴

Affiliations

¹ Riverine Hospital, Cuttack, India.
² Bagchi Shri Shankara Cancer Centre and Research Institute, Bhubaneswar, Odisha, India.
³ All India Institute of Medical Sciences, Bhopal, India.
⁴ All India Institute of Medical Sciences, Bhopal, India. Electronic address: madhavanranjit@gmail.com.

PMID: 40414431
DOI: 10.1016/j.urology.2025.05.040

Abstract

Objective: To evaluate the outcomes of dorsal onlay labial mucosal graft urethroplasty in female urethral stricture (FUS), a condition that remains challenging and frequently underdiagnosed due to nonspecific symptoms and diagnostic limitations.

Methods: A retrospective analysis of a prospectively maintained database was conducted, including 204 patients who underwent dorsal onlay labial mucosal graft urethroplasty for FUS between June 2013 and July 2024. Patients were included if they had symptomatic FUS confirmed by uroflowmetry, micturating cystourethrogram, or urethral calibration. Outcomes assessed included clinical success rates, recurrence, complications, and subjective improvement based on the Global Impression of Improvement (GII).

Results: The mean operative time was 97.7 ± 13 minutes, with a median hospital stay of 2 days (range: 2-11). Perioperative complications were minimal, with six cases (2.94%) of Clavien-Dindo grade 2-3 complications and no significant donor-site morbidity. At a median follow-up of 29 months (range: 7-131), clinical success rates were 98.5%, 97.5%, and 93.5% at 1-3 months, 6 months, and 2 years, respectively. Recurrence was observed in 6.5% of patients at 2 years, with 4 requiring repeat urethroplasty. Symptom improvement was reported by 95% of patients at 1-3 months and 88.1% at 2 years.

Conclusion: Dorsal onlay labial mucosal graft urethroplasty is a safe and effective treatment for FUS, with high success rates, minimal complications, and durable outcomes. This study, the largest single-surgeon series, highlights the utility of this approach as a reliable option for managing this underdiagnosed condition.