Labia minora vs buccal mucosal graft urethroplasty in female urethral strictures. A prospective, parallel arm, non inferiority, Randomized controlled trial.

Female urethral strictures FUS are rare but clinically significant, leading to bothersome lower urinary tract symptoms LUTS, recurrent UTIs, and poor quality of life. Endoscopic treatments such as repeated dilatation offer limited long-term efficacy, making urethroplasty the definitive management option. Among reconstructive choices both flap and graft urethroplasties have been described with oral buccal mucosa and genital labia minora tissues being the most widely studied graft sources.

Buccal mucosal graft BMG urethroplasty has been established as a reliable technique with high success rates and durable functional outcomes. However, harvesting BMG is associated with early donor site morbidities such as pain, bleeding, and swelling, and potential long-term complications including changes in speech, smile, chewing ability, paraesthesia, and trismus. These drawbacks are particularly relevant in women of reproductive and working age, where cosmetic, functional, and quality-of-life concerns carry significant weight.

Labia minora graft LMG urethroplasty, first described by Gozzi and later supported by Rehder and others, offers a well-vascularized, non keratinized, moist epithelial surface that is histologically similar to buccal mucosa. It is hairless, elastic, and easier to harvest in the same operative field, allowing a single surgical team to perform both graft harvest and urethral reconstruction. Importantly, LMG avoids the morbidity associated with oral graft harvest and has shown promising results in terms of Qmax improvement, PVR reduction, and symptom relief in small series.

Given the lack of consensus on the optimal graft material for FUS and the potential advantages of labia minora grafts in minimizing donor-site morbidity while maintaining functional efficacy, a direct comparison between BMG and LMG urethroplasty is both timely and clinically relevant. Our study is designed to evaluate whether labia minora graft urethroplasty is non-inferior to buccal mucosal graft urethroplasty in restoring urinary function, with the added benefit of reducing donor-site complications.