Female urethroplasty with oral mucosa graft: A safe surgery with a high success rate for patients with urethral strictures

ABSTRACT Purpose: Female urethral stricture (FUS) is a rare condition; however, both its diagnosis and management remain subjects of debate in urology. This study aimed to evaluate the safety and efficacy of female urethroplasty using an oral mucosal graft, emphasizing its low complication rate, and is based on the largest Brazilian single-center case series to date. Materials and Methods: This retrospective analysis included patients who underwent urethroplasty at Hospital do Servidor Público Estadual de São Paulo between 2018 and 2024. Urodynamic parameters, including maximum flow rate ( Q max ) and detrusor pressure at maximum flow (Pdet Q max ), were assessed. Clinical symptoms were evaluated using the International Prostate Symptom Score (IPSS), and urinary incontinence was assessed using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form preoperatively and postoperatively. Statistical analysis was performed using Statistical Package for the Social Sciences version 22.0. Results: Twenty-two urethroplasties were performed in women with a mean age of 52 years, all exhibiting urodynamic evidence of bladder outlet obstruction. The mean preoperative Q max was 8.45 mL/s, and the mean Pdet Q max was 69.05 cm H 2 O. Postoperatively, Q max improved significantly to 23.3 mL/s ( P = 0.002). Quality of life (QoL) improved markedly, with the IPSS-QoL score decreasing from 6 to 0 ( P = 0.001), and overall IPSS declining from 23.46 to 9.08 ( P = 0.006). Urinary incontinence scores remained stable, indicating no occurrence of de novo incontinence. Conclusion: Urethroplasty using oral mucosal grafts is a safe and effective surgical option for FUS, providing significant improvements in urinary flow and symptoms without increasing the risk of postoperative incontinence.