Cem Tuğrul GEZMİŞ, Nusret Can ÇİLESİZ, Buğra ÇETİN, Basri ÇAKIROĞLU, Ali EROĞLU, Mustafa Bahadır Can BALCI
The New Journal of Urology - 2026;21(1):22-29
Objective: Buccal mucosa graft (BMG) urethroplasty is a well-established treatment option for complex anterior urethral strictures. However, factors affecting surgical outcomes remain under investigation. This study aimed to evaluate the impact of stricture length and smoking on surgical success following dorsolateral onlay BMG urethroplasty. Materials and Methods: This retrospective observational study included 51 patients who underwent single-stage dorsolateral onlay BMG urethroplasty between 2021 and 2025. Patients with short strictures (<1.5 cm), urethral fistula or abscess, prior failed urethroplasty, or oral mucosal pathology were excluded. The primary outcome was surgical success, defined as the absence of obstructive symptoms and the need for further intervention. Statistical analysis included the Mann-Whitney U test, Fisher's exact test, and logistic regression. Results: The overall success rate was 74.5%. Patients in the success group had significantly shorter strictures compared to the failure group (median: 2.1 [2.0-2.8] cm vs. 5.0 [2.25-5.25] cm; p=0.002), and smoking prevalence was lower (21.1% vs. 69.2%; p=0.005). No significant differences were observed in age, comorbidities, stricture location, etiology, or preoperative Qmax. In the multivariate analysis, stricture length (OR: 0.461; 95% CI: 0.252-0.844; p=0.012) and smoking (OR: 5.572; 95% CI: 1.130-27.845; p=0.035) remained independent predictors of surgical failure. Conclusions: Stricture length and smoking are independent risk factors for failure following dorsolateral BMG urethroplasty. These factors should be addressed during preoperative counseling.
