Controversies in urethral reconstruction

Urethral strictures are a frequent source of lower urinary tract symptoms in men. Open urethroplasty is regarded as the gold-standard treatment for urethral stricture disease. The treatment for urethral strictures is a continually evolving process and there is renewed controversy over the best approach to take in reconstructing the urethra, since the superiority of one approach over another has not yet been clearly defined. Anterior urethroplasty can be treated, with low morbidity, in an outpatient surgical setting, thus decreasing the impact of urethroplasty. In order to improve outcome in adult patients when the penile shaft is involved, reconstructive urethral surgeons have learned to apply the principles of delicate tissue handling, and the development of minimally invasive techniques. Genital or extra-genital 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 oral mucosa was introduced in genital reconstructive surgery and has become popular for urethral reconstructions. 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 and new engineered material are a part of our future.