Transurethral dorsal buccal graft urethroplasty for proximal female urethral strictures

Introduction and hypothesis We present a novel outpatient transurethral dorsal buccal graft urethroplasty for managing proximal female urethral strictures. Methods A 69-year-old female presented with a 2.5-year history of slowing urinary stream. After discussing treatment options, she opted for transurethral dorsal buccal graft urethroplasty. The procedure begins with buccal graft harvest, and care is taken to avoid Stetson's duct. A nasal speculum is placed transurethrally, distal to the stricture. The full length of the dorsal urethra is incised superficially. A suture-passing device is used to place three sutures at the bladder neck and then through the buccal graft. The sutures are tied transurethrally using a laparoscopic knot pusher, parachuting the graft into place. The distal aspect of the buccal graft is secured to the urethral meatus with interrupted suture and surgical glue used to secure the midportion of the graft. Results Following the outpatient procedure, she had an uneventful recovery, including catheter removal at 3 weeks. At 3 months she had significant improvement in her urinary stream and no stress incontinence. Conclusions The transurethral approach to dorsal buccal graft urethroplasty is technically feasible and, in the short term, effective. Longer follow-up and larger series are needed to validate this procedure.