Purpose <p>To conduct a comparative analysis of autologous adult live cultured buccal epithelial cells (AALBEC) and minced buccal mucosal graft endourethral urethroplasty (MBGEU) in treatment of bulbar urethral stricture disease (USD) by evaluating and comparing their efficacy, safety, and patient outcomes. </p> Methods <p>This study was conducted in a tertiary-care center and included 90 males with primary, &lt; 4&#xa0;cm bulbar USD. In AALBEC arm (30 patients), AALBEC was implanted after DVIU. While in the MBGEU arm (60 patients), a 1 × 1&#xa0;cm buccal mucosal graft was harvested, minced, centrifuged, and suspended in fibrin glue, and after DVIU, the suspension was instilled via a 5-Fr ureteric catheter over the urethrotomy site. The primary objective was to compare success rates. The secondary objectives were to compare changes in the American Urological Association (AUA) symptom score, peak flow rate (Qmax), and post-void residue (PVRU) post-operatively and also to look for any adverse events related to surgery.</p> Results <p>The success rate of AALBEC was 73.33% and of MBGEU was 90% at 6&#xa0;months (<i>p</i> 0.041). The stricture recurred in eight and six patients, respectively. Although both groups showed a significant increase in Qmax compared to preoperative values, MBGEU group demonstrated significantly greater improvement in Qmax at 3&#xa0;months (<i>p</i> 0.002) and 6&#xa0;months (<i>p</i> &lt; 0.0001) compared to the AALBEC group. No significant donor site morbidity was seen. In AALBEC group, two patients had sepsis in postoperative period.</p> Conclusion <p>The medium-term success of MBGEU is encouraging over AALBEC. However, a longer follow-up and further studies with a larger sample size are required.</p>