Male Urethral Stricture Disease Research Articles

Non-invasive assessment of the dynamics of change in the vascular bed in the buccal autograph during treatment of extended urethral strictures

The male urethral stricture disease treatment despite all successful achievements and treatment options still remains one of the most actual and complex problems of modern urology. The presence of prolonged urethral strictures complicated with such factors as expressed scared deformation, infection, fistulae, previous unsuccessful urethral interventions, total urethral obliteration require the use of two- or multistage operations. In the light of recent times, the improvement methods dedicated to buccal mucosa graft adaptation assessment and autotransplant microvascularity evaluation are very relevant nowadays. In this study we made an attempt to estimate the dermatoscopy role in objective assessment of buccal mucosa graft microvascular network after two staged substitutive urethroplasty.The analysis of graft microphotos made in different time periods after urethroplasty allows us to define the main thing. In our point of view, the absence of evaluation changes after 90–120 postoperative days allows us to estimate a correct time for the second stage of urethroplasty-tubularization. stages of microvasculature evolution.Considering the statement that microvasculature evolution is the evolution of its graft, we think that the correct research direction is to study microangiogenesis stimulation methods.

Male urethral stricture disease in a tertiary hospital in Port Harcourt, Nigeria: a five-year review of features, management and outcome.

Introduction: The aim is to assess the early impact of the current increased use of transurethral endoscopic procedures and emerging technologies on the management of urethral stricture disease (USD) in adult males at the University of Port Harcourt Teaching Hospital (UPTH), Nigeria. Material and Methods: The design of the study was cross-sectional and descriptive. Secondary data of patients treated between 01/6/2017 to 30/6/2022, with confirmed diagnosis of USD were used. Their registration numbers were used to access their records at the Health Records Department of the Hospital. Information obtained included sociodemographic data, aetiology, clinical features, types, sites and diagnostic tests of male USD, , uroflowmetry, urethral, and abdominopelvic ultrasonography, cystourethrography results, treatment methods, outcomes, complications and co-morbidities of USD. Data obtained were analyzed with simple statistics and presented. Results: Of 10,450 Urology patients 245 had USD. Data on 224 were found and analyzed. Their age profiles in years were mean, 45.7±18.6; age range 10-95. Married were 174 (77.68%). Urethral strictures were post inflammatory 126(56.25%); post traumatic 43.75%; bulbar,73(32.59%); bulbomembranous23.22%; posterior urethral 52(23.21%); penile 34(15.18%); and pan urethral 13, (5.18%). At presentation, 105 (46.88%) were hypertensive; 40.2% had UTI with Gram-negative bacilli. Recurrence of strictures occurred 6 months to one year after DVIU; 2 months to 6 years after urethroplasty. Non-compliance with schedules and follow-p occurred in 111 (49.55%) patients. Conclusion: USD prevalence was 24/1000 urology patients. UTIs were probably healthcare and prolonged catherization associated. Screening/review of service processes warranted. Lack of validated tools for measurement of outcome or dependent treatment variables made comparative studies unrealistic.

Comprehensive proteomic characterization of urethral stricture disease in the Chinese population.

Male urethral stricture disease (USD) is predominantly characterized by scar formation. There are few effective therapeutic drugs, and comprehensive molecular characterizations of USD formation remain undefined. The proteomic profiling of twelve scar tissues and five matched normal adjacent tissues (NATs). Proteomic analysis methods were applied to explore the molecular characterizations of USD formation, including uncovering mechanistic pathways and providing novel biomarkers for scar formation. Comparative proteomic analysis showed that the extracellular matrix (ECM) and complement cascade signaling were predominant in scar tissues. COL11A1 and CD248 significantly contributed to the accumulation of ECM components. Our study presented diverse molecular mechanisms of scar formation across different ages and suggested the potential effects of PXK in Age 1 (<45) patients. Furthermore, immune infiltration studies indicated the therapeutic potential of inhibiting the complement system (C4A, C4B) in Age 2 (≥45) patients, providing a potential clinical strategy for USD. This study illustrated the pathogenesis of USD formation and the diverse characteristics of USD patients with different ages, enhancing our understanding of the disease's pathogenesis and providing a valuable resource for USD treatment.

Management Patterns of Male Urethral Stricture Disease among Urologists: What Do the Guidelines Say? What Do Urologists Do?

The aim of the present study is to evaluate and analyze the daily clinical practice for male urethral stricture disease (MUSD) among urologists. Considering the latest guidelines on urethral stricture disease, a survey was developed regarding the various treatment options and preferences in different sites of male urethral stricture disease. The survey was sent to urologists via e-mail and phone application. A total of 266 urologists completed the survey and were included in the final analysis. In regard to workplace, 62 (23.3%), 58 (21.8%), 71 (26.7%), and 75 (28.2%) respondents worked in university hospitals, training and research hospitals, state hospitals, and private practice hospitals, respectively. In regard to the diagnostic method used in male urethral strictures, 88.7% of the participants would choose uroflowmetry + postvoiding residual (UF + PVR), and 64.6% would choose retrograde urethrography (RUG). Direct vision internal urethrotomy (DVIU) was the most frequently chosen method in penile urethral strictures (PUS), being chosen by 72.9%. Direct vision anterior internal urethrotomy was the most common method for both ≤2 cm and >2 cm strictures, 63.1%, and 30.8%, respectively. The most preferred graft for augmentation urethroplasty was buccal mucosa (75.8%). Endoscopic incision/resection (transurethral resection (TUR)) is the most frequently applied treatment method for posterior urethral/vesicourethral anastomotic strictures (86.4%). The present study clearly shows that most urologists still prefer DVIU and urethral dilatation to urethroplasty in MUSD, which contradicts current guidelines. Urologists should be encouraged to perform urethroplasty and/or refer patients to experienced centres for recurrent MUSD.

V08-10 ENDOSCOPIC URETHROPLASTY FOR MANAGEMENT OF MALE MEMBRANOUS URETHRAL STRICTURE

You have accessJournal of UrologyCME1 Apr 2023V08-10 ENDOSCOPIC URETHROPLASTY FOR MANAGEMENT OF MALE MEMBRANOUS URETHRAL STRICTURE Garrett Ungerer, Jayson Kemble, and Jonathan Warner Garrett UngererGarrett Ungerer More articles by this author , Jayson KembleJayson Kemble More articles by this author , and Jonathan WarnerJonathan Warner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003306.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethral stricture disease remains a challenging urologic problem, often requiring open repair using grafts or tissue flaps. While endoscopic management offers advantages including minimizing additional surgical trauma to the already scarred urethra and pelvic floor, urethral dilation and/or urethrotomy have been shown to have less durable outcomes compared to other urethroplasty techniques (end-to-end, graft, flap, or two-stage urethroplasty). In this video, we demonstrate a minimally invasive endoscopic approach to urethroplasty using buccal grafting for management of male membranous urethral stricture disease. METHODS: The procedure was performed for management of an 8mm flow limiting stricture within the membranous urethra in a male patient with prior history of prostate cancer managed by radiation who subsequently developed an 8mm flow limiting membranous stricture. The patient is prepped in dorsal lithotomy position. Under direct visualization via cystoscopy, the stricture is first balloon dilated. Next, a posterior strip of the superficial mucosa is resected from the bladder neck to just distal to the area of stricture, creating a 1cm wide bed for the graft to lay. After the defect is measured, a buccal mucosa graft is harvested in standard fashion. Two sutures are placed through the distal corners of the graft with the graft still outside the urethra, and the proximal end of the graft is then secured to the bladder neck using the RD 180 endoscopic suturing device. The proximal suture is cinched tight, pulling the graft to the bladder neck, and the distal end of the graft is pulled tight and flat along the defect using the two sutures attached to the distal graft. The graft is anchored to the posterior urethra using endoscopic Secure Straps. Once the graft is secure, a wire is passed into the bladder under direct visualization and a catheter is passed over wire to hold the graft flat during the subsequent 4 weeks. RESULTS: The procedure lasted 2.5 hours without any complications. Estimated blood loss was 50cc. Following the procedure, the patient was discharged home with a catheter in place. Catheter was removed at 4 weeks. At 10 weeks post-op, cystoscopy showed good graft viability, and peak flow was 20 ml/sec compared to 4 ml/sec pre-operatively. At six months, he continues to do well without evidence of recurrent urethral stricture. CONCLUSIONS: Endoscopic urethroplasty using buccal graft appears to offer a safe and effective repair option that could be considered for management of ureteral strictures. Source of Funding: none to report © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e751 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Garrett Ungerer More articles by this author Jayson Kemble More articles by this author Jonathan Warner More articles by this author Expand All Advertisement PDF downloadLoading ...

Male urethral stricture disease: why management guidelines are challenging in low-income countries.

Urethral stricture disease (USD) is one of the commonest urological pathologies in adult men in low- or low-middle-income countries, providing a significant work burden for the small number of specialist surgeons who are able to provide appropriate treatment. The underlying causes of anterior urethral stricture relate to urethral fibrosis from sexually transmitted infection, with posterior urethral disruption secondary to pelvic trauma being an equally common cause of USD in many countries in sub-Saharan Africa. Anterior urethral strictures are often long, and multifocal, and bulbo-prostatic disruptions are usually due to relatively low-velocity pelvic trauma. The management options available in resource-poor settings are often severely limited by the individual's ability to pay for care, the availability of a specialist surgeon and, importantly, a shortage of functioning endoscopic equipment for less-invasive treatments. Consequently, reconstructive surgery is often regarded by the patient, and surgeon, as the most cost-effective and, therefore, primary means of treating a urethral stricture once urethral dilatation has failed. Regional anaesthetic techniques have limited the adoption of free-graft augmentation as an alternative to pedicled flaps of locally available skin for reconstruction, whilst an inability to provide tension-free bulbo-prostatic anastomoses has negatively impacted the outcome from the treatment of pelvic fracture disruption injuries in much of sub-Saharan Africa. However, Urolink has found that local surgeons can be taught sustainable skills required for successful complex urethroplasty when supported by longitudinal mentorship in the management of difficult clinical issues. Evidence-based practice is known to improve the standard of care in specific conditions in high-income countries, including the management of male USD. However, guidelines developed in high-income countries are not necessarily appropriate for stricture management in less well-resourced healthcare environments but could be adapted to help improve the delivery of stricture care for men in low- or low-middle income countries.

Recurrent Anterior Urethral Stricture: Challenges and Solutions.

Recurrent male anterior urethral stricture disease is a complex surgical challenge that should be managed by reconstructive urologists with experience in stricture management. Diagnosis of recurrence requires both anatomic narrowing and patient symptoms identified on validated questionnaires, with limited role for intervention in asymptomatic treatment “failures”. Endoscopic management has a very specific role in recurrence, and the choice of technique for urethroplasty depends on pre-operative urethrography and cystoscopy. Surgical success depends on addressing patient concerns, complete stricture excision, tissue quality optimization, and the use of multi-stage repair when indicated. Augmentation with genital skin flaps and/or grafts is often required, with buccal mucosa as the ideal graft source if local tissue is compromised. Salvage options including urinary diversion and perineal urethrostomy must also be considered in debilitated patients with severe disease or repeated treatment failures. Unique patient populations including patients with hypospadias and lichen sclerosis are among the highest risk for repeated recurrence and require special care in surgical technique, graft selection, and post-operative management.

Current management of male urethral stricture disease

Current management of male urethral stricture disease

MP60-20 DEVELOPMENT OF A LARGE ANIMAL URETHRAL STRICTURE MODEL IN CANINES

INTRODUCTION AND OBJECTIVE: Male urethral stricture disease (USD) is a relatively common condition that can lead to significant voiding symptoms requiring multiple endoscopic and open procedures. Existing pre-clinical models of USD are limited to small animals. We sought to develop a large animal urethral model in canines for testing and validating future diagnostic and therapeutic innovations. METHODS: 3 canines (Marshall Bioresourcers, 25-30 Kgs, 9-12 months old) underwent scrotal urethrostomy for urethral access and urine diversion. Following a 3-4 week recovery period, a pre-intervention retrograde urethrogram (RUG) was performed. Circumferential thermocoagulation of the defunctionalized distal urethral segment was performed using pediatric resectoscope (Karl Storz, Tuttlingen, Germany) for 30-45 sec in intermittent bursts at 25-30 W power setting, until visible blanching with minimal tissue reaction was observed. Further cystoscopic, radiographic and perfusion (Moor laser Doppler Flowmetry; LDF) monitoring was performed at 2 & 8 week intervals before subsequent euthanasia and tissue harvest. Histologic examination was performed using H&E, Hart’s and Gomori’s trichrome stains. RESULTS: Comparative analysis between pre & post RUG indicated an average 50% reduction in urethral caliber which was confirmed via cystoscopic evaluations. Histologically, the urethral lumen was markedly narrowed, and the corpora spongiosa was largely replaced by proliferating fibroblasts and mature collagen. CONCLUSIONS: We describe the first successful urethral stricture disease model in an anatomically-comparable and physiologically-similar large animal. This pre-clinical model will facilitate development of novel technical and surgical therapy options for USD.Source of Funding: Johns Hopkins Tech Ventures (JHTV) Thalheimer Translational Research Fund

Male urethral stricture disease in a regional centre: 10 years of experience.

Male urethral stricture disease is a challenging condition with a propensity for recurrence following endoscopic management. In recent years, earlier definitive urethral reconstruction has been advocated through international guidelines, prompted by series suggesting the underutilization of urethroplasty at rates of 0.6-0.8%. However, little local data exists to characterize our urethral stricture patients and we aimed to characterize the management of patients with urethral stricture disease presenting over a 10-year period to a single regional centre. Patients with urethral stricture disease and admitted to a regional health service were identified. Retrospective chart review was undertaken for patients detailing basic demographics, stricture characteristics, clinical management and follow up. We identified 360 patients with median age 69 years (interquartile range 56-77). A total of 191 (53%) presented with lower urinary tract symptoms, 122 (34%) urethral strictures were incidental, and 13% presented in urinary retention. Bulbar urethral strictures were the commonest strictures at 40% with most being spontaneous or idiopathic (67%). A total of 339 patients had treatment during their first admission, 48% of patients had subsequent treatment on a second episode, and over 20% had a third or subsequent treatment. Only 21 (5.8%) underwent urethroplasty. Urethral dilatation and optical urethrotomy were most commonly performed (54%). With follow up 19 months (interquartile range 2-56), 205 (57%) were voiding, 38 (11%) were performing intermittent catheterization, and 59 were catheterized permanently. Definitive urethral reconstruction appears underutilized in our cohort of patients. A high proportion of incidentally presenting urethral strictures emphasizes the importance of wider education to optimize patient outcomes.

A Comprehensive Review Emphasizing Anatomy, Etiology, Diagnosis, and Treatment of Male Urethral Stricture Disease.

To date, urethral stricture disease in men, though relatively common, represents an often poorly managed condition. Therefore, this article is dedicated to encompassing the currently existing data upon anatomy, etiology, symptoms, diagnosis, and treatment of the disease, based on more than 40 years of experience at a tertiary referral center and a PubMed literature review enclosing publications until September 2018.

PD22-07 ANALYSIS OF PROGRESSIVE LUMENAL EXPANSION ON URETHRAL MICROPERFUSION USING LASER DOPPLER FLOWMETRY IN NEW ZEALAND WHITE MALE RABBITS

INTRODUCTION AND OBJECTIVES:Male urethral stricture disease (USD) is a relatively common condition often requiring multiple endoscopic and open procedures as treatment. Repeat urethral catheterizat...

MP67-20 DIRECTED NON-ONCOLOGIC PATHOLOGY REVIEW IDENTIFIES A HIGH PREVALENCE OF CHRONIC INFLAMMATION WITHIN ANTERIOR URETHROPLASTY STRICTURE SPECIMENS

INTRODUCTION AND OBJECTIVES:Following anterior urethroplasty (AU) for male urethral stricture disease (USD) surgical pathology is seldom obtained or focuses on excluding malignancy. This potentiall...

272 Socioeconomic Factors Influence the Utilization of Urethroplasty in the Treatment of Male Urethral Stricture Disease

Male urethral stricture disease is a commonly encountered urologic condition. Treatment options include endoscopic approaches versus urethroplasty. Previously identified provider-level barriers to urethroplasty utilization include access to a reconstructive surgeon, geographic disparities in care, and provider concerns regarding complications. We sought to determine patient related and socioeconomic factors influencing urethroplasty utilization compared to endoscopic management. A retrospective review using the Healthcare Cost and Utilization Project State Inpatient and Ambulatory Surgery and Services Databases for California and Florida was performed. Adult men with a diagnosis of urethral stricture who underwent urethroplasty or endoscopic dilation/urethrotomy between 2007-2011 for California and 2009-2014 for Florida were identified by ICD-9 or CPT codes. Patients were assessed for age, insurance provider, median household income, Charlson comorbidity index, race, and number of endoscopic procedures. A stepwise multivariate analysis model was fit to assess factors influencing treatment modality (urethroplasty vs. endoscopic management). 27,641 patients were identified who underwent treatment for urethral stricture disease. 1,692 underwent urethroplasty (6.1%). Factors favoring utilization of urethroplasty include younger age, lower Charlson comorbidity score, higher income quartile, and increased number of endoscopic treatments (Figure 1). Hispanics were more likely to undergo endoscopic management compared to Caucasians.

Specific characteristics of urethral strictures in a developing country (Brazil).

Evaluate the main etiologies and clinical characteristics of male urethral stricture disease (USD) in Brazil. This multicentric study was performed using retrospective data collected from six Brazilian referral centers of urethral reconstruction. The database comprised data from 899 patients with USD who had undergone surgical treatment from 2008 to 2018. Age, stricture site and primary stricture etiology were identified for each patient. The mean age was 52.13 ± 16.9years. The most common etiology was iatrogenic (43.4%), followed by idiopathic (21.7%), trauma (21.5%) and inflammatory (13.7%). Of the iatrogenic causes, 59% were secondary to urethral instrumentation (60% by urethral catheterization and 40% by transurethral procedures), 24.8% by other procedures (prostatectomy, radiotherapy, postectomy) and 16.2% by failed hypospadia repairs. Pelvic fracture urethral distraction injuries were responsible for most of the trauma-related strictures (62.7%). When stratified by age, the most common stricture etiology was trauma in the 0-39years old group (42.8%), idiopathic in the 40-59years old group (32.4%) and iatrogenic in patients over 60years old (68%). In regard to the stricture site, 80% presented with an anterior urethral stricture and 20% with a posterior stenosis. In the anterior stenosis group, the most common stricture site was bulbar (39.5%). In Brazil, as in many developed countries, the most common cause of urethral stricture diseases is iatrogenic, especially urethral catheterization. These findings emphasize the need of a careful urethral manipulation and a better training of healthcare professionals. Trauma is still responsible for a great proportion of strictures and inflammatory etiologies are now less frequently observed.

Socioeconomic and patient-related factors for the management of male urethral stricture disease.

We sought to determine the socioeconomic and patient factors that influence the utilization of urethroplasty and location of management in the treatment of male urethral stricture disease. A retrospective review using the Healthcare Cost and Utilization Project State Inpatient and Ambulatory Surgery and Services Databases for California and Florida was performed. Adult men with a diagnosis of urethral stricture who underwent treatment with urethroplasty or endoscopic dilation/urethrotomy between 2007 and 2011 in California and 2009 and 2014 in Florida were identified by ICD-9 or CPT codes. Patients were categorized based on whether they had a urethroplasty or serial dilations/urethrotomies. Patients were assessed for age, insurance provider, median household income by zip code, Charlson Comorbidity Index, race, prior stricture management, and location of the index procedure. A multivariable logistic regression model was fit to assess factors influencing treatment modality (urethroplasty vs endoscopic management) and location (teaching hospital vs non-teaching hospital). Twenty seven thousand, five hundred and sixty-eight patients were identified that underwent treatment for USD. 25,864 (93.8%) treated via endoscopic approaches and 1704 (6.2%) treated with urethroplasty. Factors favoring utilization of urethroplasty include younger age, lower Charlson Comorbidity score, higher zip code median income quartile, private insurance, prior endoscopic treatment, and management at a teaching hospital. Socioeconomic predictors of urethroplasty utilization include higher income status and private insurance. Patient-specific factors influencing urethroplasty were younger age and fewer medical comorbidities. A primary driver of urethroplasty utilization was treatment at a teaching hospital. Older and Hispanic patients were less likely to seek care at these facilities.

Bone mineral density in ankylosing spondylitis

Male urethral stricture disease is a challenging urological condition that affects nearly a third of men 65 years old or older. Management options include dilation and urethrotomy as well as urethroplasty, an open approach with increased morbidity and durability. Presently optimal management remains debated. In this study we focus on emergent procedures required by male patients in the Veterans Health Administration after stricture treatment as an indicator of clinically significant complications, comparing treatment approaches.We performed an institutional review board approved, retrospective, cohort study of male veterans with urethral stricture from 2005 to 2014. Our independent variable was immediate or delayed urethroplasty or continued endoscopic treatments. Our dependent variable was a stricture related procedure performed in the emergent or urgent care setting. We used a binary logistic regression model to model the likelihood of an adverse outcome as predicted by treatment type.In our cohort of 9,632 patients 1.8% underwent immediate urethroplasty and 3% underwent delayed urethroplasty. Of the operated men 5.3% had an adverse outcome (5% following delayed urethroplasty or continued endoscopic treatments and 1% after immediate urethroplasty, p = 0.04). On multivariate analysis repeat endoscopy and delayed urethroplasty trended toward worsening odds of adverse outcomes (p = 0.07 and p = 0.08, respectively).In the Veterans Health Administration system men who undergo repeated scheduled endoscopic treatments for urethral stricture may be at increased risk for emergent procedures, even if they eventually progress to urethroplasty, compared to men who undergo urethroplasty immediately after a failed endoscopic intervention.

Résultats de l’urétroplastie anastomotique pour rétrécissement de l’urètre masculin

To report our experience with anastomotic uretroplasty (AU) due to male urethral stricture disease (USD) and to identify factors affecting the results. We conducted a retrospective study over a period of 4 years and 6 months (July 2012 to December 2016). Any subsequent use of endoscopic urethrotomy or new urethroplasty was considered a failure. Forty-eight cases were included. The mean age of patients was 53.5±17.3 years (23-87 years). Urinary retention was the reason for consultation in 42 cases (87.5%). The most common localization of USD was the bulbar urethra (n=45). The mean length of USD was 1.23±0.62cm (0.5-3cm) with a median length of 1cm. The etiology was post-infectious in 56.3% of cases. More than half (58.3%) of patients had already undergone at least one urethral manipulation. After an average follow-up of 21.1±12.6 months (1 to 52 months), the overall success rate was 77.1%. In univariate analysis, length, cause and location of the stricture, age of patient, the presenting symptoms of the stricture, previous urethral manipulation and surgeon experience did not significantly impact on the success rate of anastomotic urethroplasty at one and two years follow-up. The AU had provided good results in our practice. The infectious origin of the stricture and previous urethral manipulation did not significantly impact the result of this surgical technique. 4.

Endoscopic Management of Urethral Stricture: Review and Practice Algorithm for Management of Male Urethral Stricture Disease.

Male urethral stricture disease is characterized by the formation of scar tissue within the urethra resulting in lower urinary tract symptoms, infection, and potentially kidney dysfunction. There is significant variability in clinical practice for the treatment of urethral stricture. We sought to summarize the known data on endoscopic management of urethral stricture disease as part of this larger edition on urethral stricture management. Older studies quoted high rates of success with endoscopic management of urethral stricture, including repeated DVIU. There is now evidence to support a limited role of endoscopic intervention in the management of urethral stricture, and especially strong evidence that repeated endoscopic procedures are not effective. There is poor evidence to support the long-term efficacy of endoscopic urethral stricture management. Furthermore, novel advances in adjunctive therapies have not yet demonstrated durable patency. We discuss the limited role of endoscopic management and suggest an algorithm for its use in stricture management.

Substitution urethroplasty using oral mucosa graft for male anterior urethral stricture disease: Current topics and reviews.

Male anterior urethral stricture is scarring of the subepithelial tissue of the corpus spongiosum that constricts the urethral lumen, decreasing the urinary stream. Its surgical management is a challenging problem, and has changed dramatically in the past several decades. Open surgical repair using grafts or flaps, called substitution urethroplasty, has become the gold standard procedure for anterior urethral strictures that are not amenable to excision and primary anastomosis. Oral mucosa harvested from the inner cheek (buccal mucosa) is an ideal material, and is most commonly used for substitution urethroplasty, and lingual mucosa harvested from the underside of the tongue has recently emerged as an alternative material with equivalent outcome. Onlay augmentation of oral mucosa graft on the ventral side (ventral onlay) or dorsal side (dorsal onlay, Barbagli procedure) has been widely used for bulbar urethral stricture with comparable success rates. In bulbar urethral strictures containing obliterative or nearly obliterative segments, either a two-sided dorsal plus ventral onlay (Palminteri technique) or a combination of excision and primary anastomosis and onlay augmentation (augmented anastomotic urethroplasty) are the procedures of choice. Most penile urethral strictures can be repaired in a one-stage procedure either by dorsal inlay with ventral sagittal urethrotomy (Asopa technique) or dorsolateral onlay with one-sided urethral dissection (Kulkarni technique); however, staged urethroplasty remains the procedure of choice for complex strictures, including strictures associated with genital lichen sclerosus or failed hypospadias. This article presents an overview of substitution urethroplasty using oral mucosa graft, and reviews current topics.