Female urethral stricture accounts for about 1% of women wıth LUTS. Several new reconstructive techniques have been described. The aim of this video is to demonstrate a simplified dorsal onlay buccal graft urethroplasty after failed vaginal flap urethroplasty. We emphasize five steps to simplify and improve the surgery: 1) identify the stricture with a bougie a boule - no need for an extensive dissection 2) dissect directly on the dorsal urethra preserving the periurethral musculature (PUM), 3) place the graft deep to the PUM, 4) close the dead space between the graft and PUM, and 5) evert redundant graft anteriorly to create a wide meatus and prevent meatal stricture.

A 63-year-old female patient presented with a history of long-standing chronic urethritis and symptomatic urethral stricture disease complicated by severe pain at the site of the urethra. She had multiple urethral dilatations, two meatoplasties, and one vaginal flap urethroplasty which failed after about 4 years. This video demonstrates the technique of dorsal onlay buccal mucosal graft.

At two-year follow-up she was asymptomatic and her uroflow had increased from 4 to 21 mL/s.

Urethroplasty using this simplified technique of buccal graft augmentation is a feasible and effective treatment for female urethral stricture.