What is the best technique for urethroplasty?

Area of Science:

• Urology
• Surgical Reconstruction
• Evidence-Based Medicine

Background:

• Optimal surgical techniques for urethral strictures lack clear evidence.
• Guidance is needed on selecting urethroplasty procedures based on stricture characteristics.

Purpose of the Study:

• To review urethroplasty options for various urethral sites and stricture types.
• To indicate the best surgical procedures for specific circumstances based on current evidence.

Main Methods:

• Systematic review of recent publications.
• Inclusion of authors' clinical experience.

Main Results:

• Short bulbar urethral strictures: excision and end-to-end anastomosis or buccal mucosal graft patch urethroplasty.
• Distal penile strictures (lichen sclerosus): staged reconstruction with buccal mucosal grafts.
• Pelvic fracture urethral injury: bulbo-prostatic anastomotic urethroplasty.
• Limited evidence for other stricture types and salvage surgery, requiring specialized judgment.

Conclusions:

• Evidence for urethral stricture surgery has advanced for common types.
• Urethroplasty remains a blend of surgical science and art, especially for complex cases.