Single-stage ventral onlay buccal mucosal graft urethroplasty for complex bulbar stricture with urethrocutaneous fistula: a case report

Background Urethral stricture associated with a urethrocutaneous fistula (UCF) represents an uncommon and challenging reconstructive scenario. Although staged reconstruction and oral mucosal graft techniques have been described, experience with single-stage ventral onlay BMG urethroplasty in this setting remains limited. Case presentation A 54-year-old man presented with obstructive lower urinary tract symptoms and acute right perineal swelling with urine leakage during micturition. Uroflowmetry demonstrated a Qmax of 3.3 mL/s with a post-void residual (PVR) of 160 mL. Ascending urethrography showed a short mid-bulbar urethral stricture, whilst magnetic resonance imaging (MRI) demonstrated an associated approximately 5-cm urethrocutaneous fistulous tract. Cystoscopy revealed a 1.5-cm mid-bulbar stricture with mild spongiofibrosis and a preserved urethral plate. Suprapubic diversion was performed, and after 2 weeks of urethral rest, with resolution of local inflammation and clinical healing of the fistula, the patient underwent single-stage ventral onlay BMG urethroplasty. At 6 months, he remained asymptomatic with satisfactory urinary flow and no clinical evidence of recurrent stricture or fistula. Conclusion In this selected patient, single-stage ventral onlay BMG urethroplasty following urethral rest was feasible and associated with a favourable short-term outcome. Longer follow-up and additional cases are required to assess the durability and broader applicability of this approach.