Katiyar et al. Afr J Urol (2021) 27:127 https://doi.org/10.1186/s12301-021-00231-0 ORIGINAL RESEARCH Urethral meatus preserving ventral onlay augmentation urethroplasty for female urethral stricture: our technique with initial experience Varun Kumar Katiyar 1 , Rajeev Sood 1 , Anurag Singla 1 , Hemant Kumar Goel 1* , Nikhil Khattar 2 and Varun Gunavanthe 3 Abstract Background: Female urethral stricture (FUS) is an uncommon cause of lower urinary tract symptoms (LUTS) in women. Reconstructive techniques are being increasingly used for strictures resistant to the more conservative form of management. Most forms of reconstruction require cutting open of urethral meatus, thereby resulting in some loss of the meatus function. We hereby describe the technique of urethral meatus sparing ventral onlay mucosal graft augmentation urethroplasty with our initial experience. Methods: We performed this procedure in 10 cases of FUS with normal meatus and prospectively studied the out- comes over a period of 6 months follow-up. Results: There was 90 percent success rate with one recurrence. The mean Qmax increased from 7.2 to 19.5 ml/s, mean post-void residual urine (PVRU) decreased from 96.5 to 22.7 ml and the mean IPSS decreased from 26.1 to 5.7. There were no major complications noted and the patients demonstrated significant subjective and objective improvement of symptoms in the follow-up period. Conclusion: The technique of meatus sparing ventral onlay augmentation graft urethroplasty is a promising approach with good outcomes, is reproducible and has minimal complication rate. Keywords: Ventral onlay, Meatus sparing, Female urethral stricture, Augmentation urethroplasty, Substitution urethroplasty © The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. 1 Background Female urethral stricture (FUS) is an uncommon cause of lower urinary tract symptoms (LUTS) in women [1–5]. e management strategies for it are still under a process of constant refinement and evolution. Strictures refrac- tory to more conservative forms of treatment such as repeated urethral dilatations are now being increasingly managed by surgical reconstructive techniques [6, 7]. A variety of surgical reconstructive approaches have been described with most of them including the use of grafts to augment the stricture site [8–12]. The two main approaches for augmentation ure- throplasty are the dorsal (anterior wall) onlay and the ventral (posterior wall) onlay. Ventral onlay graft ure- throplasty in FUS has been used less due to theoretical risk of urethrovaginal fistula. This approach has poten- tial advantages such as avoidance of dissection around dorsal neurovascular bundle and dorsal sphincter complex, operating in a relatively avascular field and familiarity to urogynecologists [13, 14]. Potential dis- advantages are theoretical possibility of urethrovaginal fistulae, creation of hypospadiac meatus (when meatus is not preserved) [14, 15]. While the increased risk of Open Access African Journal of Urology *Correspondence: hemant.doc81@gmail.com 1 Department of Urology, ABVIMS & Dr Ram Manohar Lohia Hospital, Room No 31, New Delhi, India Full list of author information is available at the end of the article