Buccal mucosal grafts perform less favorably in a radiated setting after bulbar urethroplasty

Authors

  • Kennedy Dirk Department of Urology, Queen’s University, Kingston, Ontario, Canada
  • Seth Thomas Department of Urology, University of California, Irvine, California, USA
  • Keith F. Rourke Department of Urology, University of California, Irvine, California, USA ; Division of Urology, University of Alberta

DOI:

https://doi.org/10.5489/cuaj.9740

Keywords:

Bulbar urethral stricture; Urethroplasty; Buccal Mucosa; Outcomes

Abstract

Introduction: Buccal mucosal grafts (BMG) are the preferred tissue for substitution bulbar urethroplasty; however, it is unclear if BMG performs equally well across all stricture etiologies. The objective of this study was to examine etiology-specific outcomes of bulbar urethroplasty using BMG.

Methods: From September 2003 to May 2023, patients undergoing bulbar urethroplasty at a single center were evaluated. The primary outcome was stricture-free survival, with recurrence defined as stricture <16 Fr on followup cystoscopy. Secondary outcomes included 90-day complications (Clavien ≥2), patient-reported erectile dysfunction (ED), and satisfaction. Multivariable Cox regression analysis was used to evaluate variables associated with stricture recurrence, and Chi-squared test to assess secondary outcomes.

Results: Of 914 patients undergoing bulbar urethroplasty using BMG with a median followup of 103 months (interquartile range [IQR] 57−163), 62 recurrences were observed. The one-, five-, and 10-year estimated stricture-free survival rates were 94.9%, 92.2%, and 91.0%, respectively. On multivariable assessment, stricture etiology, in particular radiation (hazard ratio [HR] 6.3, 95% confidence interval [CI] 3.0−13.0, p<0.0001) was associated with stricture recurrence, as well as stricture length (HR 1.2, 95% CI 1.1-1.3, p=0.0001), diabetes (HR 2.0, 95%C.I. 1.1-3.7, p=0.02), and prior urethroplasty (HR 2.4, 95% CI 1.3−4.5, p=0.007). For radiation strictures, the estimated stricture-free survival rates were 71.8%, 60.5%, and 60.5% at one, five, and 10 years, respectively. No differences in ED (p=0.53) or 90-day complications (p=0.77) were observed across etiologies. Satisfaction was significantly lower in the radiation group (83.9% vs. 92.2%, p=0.04).

Conclusions: In general, urethroplasty with BMG is effective but may yield inferior outcomes in the radiated subgroup of patients. Whenever technically feasible, an anastomotic approach with stricture excision may be preferred in the radiated setting.

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Author Biography

Keith F. Rourke, Department of Urology, University of California, Irvine, California, USA ; Division of Urology, University of Alberta

Professor, Department of Urology, University of California, Irvine, California, USA

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Published

2026-10-19

How to Cite

Dirk, K., Thomas, S., & Rourke, K. F. (2026). Buccal mucosal grafts perform less favorably in a radiated setting after bulbar urethroplasty. Canadian Urological Association Journal, 21(2). https://doi.org/10.5489/cuaj.9740

Issue

Vol. 21 No. 2 (2027): CUAJ February

Section

Original Research

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