Long-term outcomes after buccal mucosa graft urethroplasty: a single-center cohort with 7-year median follow-up and systematic review of the literature.

INTRODUCTION AND OBJECTIVES: Buccal mucosa graft urethroplasty (BMGU) is the standard therapy for recurrent and complex urethral strictures. Data on outcomes beyond 5 years are scarce. This study analyzes long-term results after BMGU and compares them systematically with published cohorts. MATERIAL AND METHODS: Patients who underwent BMGU between 1996 and 2015 were identified. Exclusion criteria included female sex and prior hypospadias repair. Details of patient selection are reported in the Results section. A systematic review of the literature was conducted in accordance with the PRISMA statement. RESULTS: The response rate was 49% (115/237). Median age at surgery was 62 years. Patients had a median of 2 prior operations. Most commonly, internal urethrotomy (92%), dilatation (30%), and open reconstruction (11%) were performed. Median stricture length was 4.5 cm. Recurrence rate was 20% after a median follow-up of 7 years. Median time to recurrence was 70 months. In our cohort, longer operation duration and stricture localization, particularly bulbar and combined bulbar+penile strictures, were identified as risk factors for recurrence (p=0.002 and p=0.016, respectively). Across 14 studies (median follow-up 5-14.3 years, 7-733 patients), the pooled recurrence rate was 16.2% (362/2241), with stricture length, localization, prior surgery, lichen sclerosus, radiation, and infection as the most frequently reported risk factors. CONCLUSION: In our cohort with 20% recurrence rate after 7 years and across 14 long-term series with a pooled recurrence rate of 16.2%, BMGU consistently achieves durable long-term patency and should be preferred over repeated endoscopic procedures for recurrent or complex urethral stricture disease.