Urethral reconstruction

To present an up-to-date review on the main surgical techniques used to treat urethral strictures.

Anterior urethroplasty can be treated in outpatient surgical settings, thus decreasing the impact of urethroplasty. To improve outcome in adult patients, reconstructive surgeons have learned to apply the principles of hypospadias surgery, such as delicate tissue handling, avoidance of overlapping suture lines, tissue and the development of preputial skin flaps, to adult urethral surgery. Penile skin has been used as a free graft or harvested as a flap for some time, thanks to its location, hairless skin and durability. Since the early 1990s the use of buccal mucosa was introduced in genital reconstructive surgery and has become popular for complex urethral reconstructions. The use of fibrin glue was recently suggested to fix the buccal mucosal graft in a better way and to cover the anastomosis between the graft and urethral plate.

Urethral reconstructive surgery is changing rapidly and this change has posed problems for surgeons who see the principles that previously defined their profession becoming obsolete or unworkable. New techniques, new tools, such as fibrin glue, and new engineered material are a part of our future.