OBJECTIVE: To compare the outcomes of dorsal-onlay (DO) and ventral‑inlay (VI) buccal mucosal graft urethroplasty (BMGU). This is the first Clinical Trials Registry-India registered randomized clinical trial on female urethral stricture disease. METHODS: Women with USD underwent either DO-BMGU or VI-BMGU between September 2021 to July 2023. The primary objective was the success rates of the two techniques. The secondary objectives were duration of surgery, amount of blood loss, pain scores as assessed by Visual Analog Scale, and change in American Urological Association score, Qmax and postvoid residual. RESULTS: Of the 47 randomized participants, 20 patients in each group were taken up for final analysis. The median follow‑up period was 21months and those with less than 1year follow-up were excluded. One patient in each group had failure at 1year follow-up, giving a success rate of 95% in each arm. The median blood loss [15 mL (10-15) vs 10 mL (5-12.5), (P .012)] and median duration of surgery [44.5 minutes (40-52.5) vs 30 minutes (22-38), (P<
.001)] were significantly less for VI-BMGU than for DO-BMGU. The median Visual Analog Scale scores at 6 and 24 hours were significantly lower (P<
.001) for the VI-BMGU group but not at 48 hours. The VI-BMGU group required less analgesia (P<
.01) as well. Small sample size and single institutional experience are limitations. CONCLUSION: The outcomes of VI-BMGU are similar to those of DO-BMGU, with the additional advantages of shorter operative time, lesser blood loss, and less pain.