Reconstructing Success: Insights from a Retrospective Study and Systematic Review and Meta-Analytical Evaluation of Buccal Mucosal Graft Urethroplasty Across the Globe
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Abstract
Background: Buccal mucosal graft urethroplasty (BMGU) is now the gold standard in the treatment of anterior urethral strictures, particularly of long lengths or recurrences. But heterogeneity of outcomes, predictors of recurrence, and complication rates among populations and techniques necessitates a harmonized evidence-based synthesis. Aim and Objective: To appraise and integrate international evidence regarding the efficacy, safety, recurrence pattern, and quality-of-life at follow-up after BMGU and to determine: "What patient, disease, and surgical variables most reliably affect long-term stricture recurrence and functional recovery in anterior urethral strictures managed with BMG urethroplasty in diverse healthcare settings? Material and Methods: A systematic review and meta analyses was conducted by searching the electronic databases for published studies from 2015 to 2024 and finally ten studies (n=1228) were taken into consideration. Outcomes assessed included primarily success rate, complications, recurrence and patient related outcome measures (PROMs). Additionally, a retrospective cohort study of 150 patients with Balanitis Xerotica Obliterans (BXO) related anterior urethral strictures treated at Karuna Medical College between 2014 and 2024. Results: The meta analyses of the global studies yielded a pooled success rate of 85% with recurrence positively correlated with penile site, stricture length and ≥3 prior urethrotomies. Recurrence predictors were penile site, increased stricture length, secondary procedures, and ≥3 previous urethrotomies. Complications of erectile dysfunction and urinary infection were reported but mostly controllable. The Karuna cohort (mean age 45.2 years) showed a 98.7% short term success rate. Complications occurred in 6 patients (4%): 2 each with oral bleeding, wound infection and recurrence requiring redo surgery. Radiological and intraoperative images confirmed technical integrity. Conclusion: BMGU is a very effective and versatile surgical option for the treatment of anterior urethral strictures. Early surgery, the proper choice of technique, and the incorporation of PROMs can maximize patient-focused results. The validation from a high volume Indian center in BXO cases supports its applicability across disease etiologies and resource levels.
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Copyright (c) 2025 S. Pravin Dass, Sukanya M, Swathi N
This work is licensed under a Creative Commons Attribution 4.0 International License.
Creative Commons License All articles published in Annals of Medicine and Medical Sciences are licensed under a Creative Commons Attribution 4.0 International License.
Sukanya M, Faculty of Department of General Surgery, Karuna Medical College, Vilayodi, Chittur, Palakkad, Kerala, 678103, India.
Faculty of Department of General Surgery, Karuna Medical College, Vilayodi, Chittur, Palakkad, Kerala, 678103, India.
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