Minced buccal mucosal graft endo-urethroplasty is an emerging minimally invasive technique for the management of urethral stricture disease. However, its efficacy in treatment naïve strictures compared to previously treated strictures remains uncertain. This study aims to compare clinical outcomes of modified minced buccal mucosal graft endo-urethroplasty in primary and secondary bulbar urethral strictures and to assess its role as a treatment option in different stricture settings.

This prospective study was conducted at a tertiary care centre after institutional ethics approval. Adult male patients aged more than 18 years undergoing modified minced buccal mucosal graft endo-urethroplasty from October 2022 onwards were included. Primary strictures were defined as untreated bulbar strictures less than 2 cm in length with minimal spongiofibrosis. Secondary strictures included those with prior failed optical internal urethrotomy or urethroplasty, stricture length between 2 and 4 cm, or dense fibrosis. Patients with less than one year follow up or those lost to follow up were excluded. Patients were evaluated using clinical assessment and uroflowmetry during follow up. Success was defined as satisfactory voiding without the need for any additional instrumentation at one year.

A total of 34 patients were analyzed, including 24 patients in the primary group and 10 patients in the secondary group. At one year follow up, the success rate in the primary group was 80 percent, whereas the secondary group demonstrated a success rate of 60 percent. Failure rates were higher in the secondary group at 40 percent compared to 20 percent in the primary group. Patients in the primary group showed better functional outcomes and lower need for reintervention. The outcomes in this cohort were slightly inferior to previously reported single surgeon series, likely reflecting real world practice involving multiple surgeons.

Modified minced buccal mucosal graft endo-urethroplasty appears to be an effective minimally invasive option for selected patients with bulbar urethral strictures. The difference in outcomes between primary and secondary strictures suggests that prior interventions, stricture length and degree of fibrosis significantly influence surgical success. These findings highlight the importance of appropriate case selection when considering this technique.

Modified minced buccal mucosal graft endo-urethroplasty is a safe and promising minimally invasive technique, particularly in primary bulbar urethral strictures. Outcomes are less favorable in secondary strictures, emphasizing the need for careful patient selection. Larger studies with longer follow up are required to validate these results and define its role in the treatment algorithm of urethral stricture disease