Case Report: Dorsal inlay labial mucosa graft urethroplasty for pediatric and adolescent long-segment urethral stricture after failed hypospadias repair.

Long-segment urethral stricture represents a major and challenging complication after multiple failed hypospadias repairs. In pediatric and adolescent patients, reconstructive strategies for these complex cases remain non-standardized, and clinical evidence is limited. Oral mucosa graft urethroplasty is widely used for long and complex adult urethral strictures because of its favorable tissue characteristics. However, its role in pediatric reconstructive urology, particularly in complex post-hypospadias strictures associated with lichen sclerosus (LS), remains rarely reported. We report the case of a 15-year-old patient with severe recurrent anterior urethral stricture after multiple previous hypospadias repairs, complicated by repeated episodes of urinary retention requiring suprapubic catheterization. Histological examination of a urethral biopsy confirmed lichen sclerosus. A single-stage dorsal inlay labial mucosa graft urethroplasty was performed according to the Asopa technique. Intraoperatively, a long-segment anterior urethral stricture extending to the peno-bulbar junction was confirmed. Given the preserved urethral plate width of approximately 2 cm, a dorsal inlay approach was considered feasible. A 7 × 2 cm labial mucosa graft was harvested and quilted to the corporal bed, and the urethra was reconstructed over a 14 Ch Foley catheter with protective dartos flap coverage. The postoperative course was uneventful. At 18-month follow-up, the patient reported satisfactory voiding, no urinary tract infections, no filiform urinary stream, and no clinical evidence of recurrence. This case suggests that dorsal inlay labial mucosa graft urethroplasty may represent a feasible single-stage option in selected adolescents with complex post-hypospadias anterior urethral strictures, particularly when genital skin is unsuitable. Further pediatric experience and longer follow-up are needed to better define indications, durability, and functional outcomes.