Dorsal inlay lingual mucosa graft urethroplasty with artificial dermis donor repair for female urethral stricture.

OBJECTIVE: Female urethral stricture (FUS) is a rare but challenging condition with no consensus on optimal management. Although the lingual mucosa graft (LMG) is an effective substitute tissue, concerns regarding donor site morbidity limit its use. This study evaluated the outcomes of dorsal inlay LMG urethroplasty for FUS and the effect of bilayer artificial dermis reconstruction on lingual donor site recovery. METHODS: We retrospectively reviewed 20 women who underwent dorsal inlay LMG urethroplasty between December 2019 and June 2024. The lingual donor defect was reconstructed using bilayer artificial dermis rather than primary closure. Outcomes included maximum urinary flow rate (Qmax), AUA Symptom Index (AUA-SI), and Quality of Life (QoL). Surgical success was defined as postoperative Qmax > 12 mL/s without additional intervention. Continence was assessed using the ICIQ-UI-SF. Donor site morbidity (pain, speech, diet) was evaluated using the Oral Mucositis Daily Questionnaire. RESULTS: Median age was 52 years, median stricture length 2 cm, and median follow-up 16 months. Surgical success was achieved in 95% (19/20) of patients. At 12 months, voiding parameters improved significantly (p < 0.001): median Qmax increased from 6.5 to 20.5 mL/s, AUA-SI decreased from 25 to 4, and QoL improved from 5 to 1. No de novo stress or urge incontinence occurred. Donor site recovery was rapid, with pain resolving by day 14 and all patients regaining normal speech and diet without tongue deviation, contracture, or permanent numbness. CONCLUSIONS: Dorsal inlay LMG urethroplasty is safe and effective for FUS in this cohort. Bilayer artificial dermis reconstruction of the donor site appears to facilitate rapid functional recovery and may mitigate concerns regarding lingual mucosa harvesting, though further comparative studies are required to confirm these benefits.