Urethral Strictures: Advances and Challenges in Reconstructive Surgery

Urethral strictures are a common and persistent condition in urology, with significant clinical implications. They are characterized by a narrowing of the urethra to less than 16 Fr, affecting approximately 0.9% of the population. In men, the most frequent location is the bulbar urethra.
Historically, treatment for urethral strictures was limited to urethral dilation and internal urethrotomy, both of which had modest success rates. These procedures often required multiple repetitions, leaving patients in a lifelong palliative care scenario without a true curative solution. Today, national and international guidelines recommend limiting these approaches to one or two attempts at most.
Urethral reconstruction is now considered the only curative treatment for urethral strictures. There are two main surgical techniques: excision and primary anastomosis urethroplasty, and substitution urethroplasty (using grafts or flaps). These interventions have a long-term success rate of approximately 80%. Currently, buccal mucosa is considered the gold standard tissue for urethral reconstruction.
Despite the significant advances in reconstructive surgery over recent decades, certain clinical scenarios remain challenging. This is particularly true for strictures occurring after prostate cancer treatment or in adult patients who have undergone hypospadias repair. However, the field continues to progress. Tissue engineering and robotics are likely to represent the next steps in reducing the morbidity associated with urethroplasty and providing more effective cures for urethral strictures