Introduction: To assess long term outcomes of dorsal buccal mucosal graft (BMG) urethroplasty for the repair of refractory vesico-urethral anastomotic stenosis (VUAS) post open radical prostatectomy. Methods: We retrospectively reviewed collected data of patients underwent buccal mucosa graft urethroplasty following at least 3 interventions for VUAS.  Patients were included if they completed 24 months after surgery. Patients’ demographics, preoperative continence status, number of dilations, and urine flow preoperatively and postoperatively were collected. Trial of void and retrograde urethrogram were done after 1-3 weeks. Patients were followed every 6 months up to 4 years by flowrate, postvoiding residual urine volume, cystourethroscopy and GRA questionnaire. Results: Twelve patients underwent dorsal BMG urethroplasty between Jan 2018-Jan 2022. Eleven out 12 patients (91%) received adjuvant radiotherapy. Strictures were in the anastomotic site and median stricture length was 3 cm (2-4). All patients were incontinent preoperatively with median preoperative flow of 4.5 mL/s (2-7 mL/s). Mean operative time and blood loss were 182 minutes and 250 mL respectively. We did not record any case of intraoperative rectal injuries. No change in erectile function was noted. Median follow up was 24 months (range 9-48 months). The median flow at 24 months was 23 ml/sec. success rate at 24 months was 91% with one patient that failed immediately post operatively. Three out of 12 patients had artificial urinary sphincter post urethroplasty. GRA score of 4-5 was found in 100% of patients Conclusions: Dorsal BMG urethroplasty post VUAS has a solid promising urinary functional outcome. Dorsally placed BMG eliminate risk of rectal injuries associated with other approaches although incontinence persisted post repair. SOURCE OF Funding: None
