Vaginal Flap Urethroplasty and Dorsal Onlay Buccal Mucosal Graft Urethroplasty for Female Urethral Stricture: A Single‐Center Experience

OBJECTIVE: Female urethral stricture (FUS) is a rare pathology often managed with ineffective repetitive transurethral treatments. Although guidelines recommend urethroplasty, high-quality evidence remains scarce due to the limited number of reported cases. We reviewed our institutional series to compare the surgical and functional outcomes between vaginal flap urethroplasty (VFU) and dorsal onlay buccal mucosal graft urethroplasty (DOBMGU), aiming to clarify the optimal surgical strategy. METHODS: We retrospectively reviewed 15 female patients undergoing urethroplasty at a single center between 2012 and 2025. VFU was mainly indicated for strictures confined to the distal urethra, whereas DOBMGU was applied to strictures involving any anatomical segment. Surgical success was strictly defined as the absence of anatomical re-stricture on cystoscopy without secondary interventions. RESULTS: VFU was performed in 7 (46.7%) and DOBMGU in 8 (53.3%). The DOBMGU group comprised distal (n = 2), mid-to-proximal (n = 3), and pan-urethral (n = 3) strictures. At a median follow-up of 12 months, DOBMGU achieved a higher success rate (87.5%, 7/8) compared to VFU (57.1%, 4/7). Both groups showed significant improvement in maximum urinary flow rate (p < 0.05). Notably, all 7 patients presenting with preoperative urinary retention achieved catheter-free status. De novo incontinence was rare (n = 1), while urinary spraying was noted only in the VFU group (n = 2). CONCLUSION: While VFU remains a valid option for distal strictures, DOBMGU demonstrated highly favorable functional reliability and anatomical stability, regardless of stricture location. Urethroplasty is a definitive treatment for FUS, offering high success rates and preservation of urinary continence.