Short-Term Outcomes of Augmentation Urethroplasty in Recurrent Urethral Stricture Following Repeated Failed Optical Internal Urethrotomy: A Prospective Study

Introduction Recurrent urethral stricture following failed optical internal urethrotomy (OIU) is a clinically challenging condition with limited prospective outcome data from South Asian tertiary care centres. Augmentation urethroplasty using buccal mucosal graft (BMG) is increasingly employed in this setting; however, its outcomes in patients with prior failed endoscopic management remain poorly characterised in the Indian literature. Methods This prospective study enrolled 20 male patients with recurrent urethral stricture following a minimum of two failed OIU procedures at a tertiary care centre in central India between September 2022 and September 2024. Pre- and post-operative International Prostate Symptom Score (IPSS) and maximum urinary flow rate (Qmax) were recorded at one, three, and six months. Postoperative complications were graded using the Clavien-Dindo classification. Success was defined as Qmax ≥15 ml/second at six months without urethral re-intervention. Statistical analysis used the Wilcoxon signed-rank test, the Friedman test, and the one-sample Wilcoxon signed-rank test for Qmax assessment. Results Mean preoperative IPSS was 17.90 ± 1.86, falling to 3.33 ± 1.19 at six months (p<0.001, Wilcoxon signed-rank test). All patients had a preoperative Qmax below 10 ml/second; mean postoperative Qmax was 17.33 ± 2.14 ml/second at six months, representing a statistically significant improvement from baseline (p<0.001). The success rate at six months was 94.4% (17/18). BMG was used in 85% of patients; dorsal onlay was the predominant technique (80%). Major complications (Clavien-Dindo Grade 3) occurred in 10% of patients; 90% experienced no or minor complications. Conclusions BMG augmentation urethroplasty achieves high short-term success rates with significant symptomatic improvement and an acceptable complication profile in recurrent urethral stricture following failed OIU, supporting its role as the procedure of choice after failed endoscopic management.