Reconstructive Management with Urethroplasty

To answer the question of which surgical technique represents the most efficient procedure for urethral reconstruction, the most common techniques are described. Depending on stricture length, stricture location, and patient history, suitable techniques are presented. Preoperative examination and intraoperative findings, such as the condition of the urethral plate, guide the choice of technique. Excision and primary anastomosis is the technique of choice in post-traumatic and short strictures. Flaps and free transplants are necessary in longer strictures. In cases of destruction of the urethral plate, two-stage urethroplasties using buccal mucosa or skin grafts are necessary. For decision making about the adequate urethroplasty technique, underlying pathophysiology, previous treatments, stricture length and location, and shape of the urethral plate have to be considered.Patient summaryAfter unsuccessful primary treatment of urethral strictures and in long urethral strictures, open urethroplasties represent the gold standard treatment. Several techniques are available. Selecting the optimal technique depends on preoperative diagnostic evaluation and intraoperative findings.