[Reconstructive urethral surgery]

Urethral strictures are independent of a patient's age and can happen in every life period. They are often iatrogenic, resulting from a transurethral surgical procedure or traumatic catheterisation. Endoscopic slotting is the surgery of choice; although this method is frequently associated with recurrence. Retrograde urethrography or cystourethrography continue to play a central role in diagnostic evaluation and treatment. There is no standardised procedure regarding the surgical technique, perioperative management, and postoperative follow-up. Evidence-based recommendations or guidelines do not exist. For a successful surgical treatment of the urethra it is important to have an excellent knowledge of the urethral and urogenital anatomy. The permanent removal of urethral strictures can only be achieved by open reconstructive surgery. Direct end-to-end urethroplasty is used, in general, for short bulbar urethral strictures, while urethroplasty with oral mucosa is used for longer bulbar and penile strictures. Urethral reconstruction using a patient-specific autologous cell transplant with MukoCell^® is an alternative to the conventional transplantation with native oral mucosa. Urethral reconstruction should be performed in specialised centres with appropriate expertise.