Comparing ventral and dorsal oral mucosal graft urethroplasty in female urethral stricture: a systematic review and meta-analysis.

PURPOSE

Reconstructive surgical options have become an alternative for female urethral stricture. Dorsal and ventral methods using oral mucosa grafts have been described, but their superiority over each other has not been evaluated. In this meta-analysis, the outcomes of dorsal and ventral techniques with oral mucosa graft in female urethroplasty have been compared.

MATERIAL AND METHOD

A systematic search of Pubmed, Scopus and Web of Science databases was performed according to the Preferred Reporting Items For Systematic Review And Meta-Analysis statement. Manuscripts published until February 2025 that reported the use of dorsal or ventral surgical approaches with oral mucosa grafts in female urethroplasty included. Success, determined based on the recurrence rate, was analyzed and compared between both groups. Complications were presented in both groups to evaluate the safety of the surgical technique.

RESULTS

A total of 320 studies were identified, with 25 meeting the inclusion criteria. The meta-analysis, including four comparative cohort studies, showed no significant difference in surgical success between the dorsal (62/69 patients) and ventral (93/103 patients) techniques (OR = 0.84, 95% CI: 0.30-2.36, p = 0.74). In the pooled analysis combining both comparative and non-comparative studies, the success rates for the dorsal and ventral techniques were 92.1% (95% CI: 89.1-95.1) and 95.5% (95% CI: 92.8-98.2), respectively, with no significant heterogeneity. A total of 4 cases of stress urinary incontinence complications were reported in the ventral approach, while 2 cases were reported using the dorsal approach. The majority of the studies (21 out of 25) provided Level 4 evidence, with only two randomized controlled trials reaching Level 2.

CONCLUSION

This meta-analysis confirms that both dorsal and ventral approaches are effective for treating female urethral stricture, with high success rates. There was no statistically significant difference in success rates between the ventral and dorsal approaches. Surgical approach selection should depend on patient factors and surgeon expertise to achieve optimal outcomes.