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Evolution and innovation in urethroplasty: a comprehensive narrative review of graft types and surgical techniques

International Journal of Impotence Research (2025)Cite this article

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Abstract

Urethroplasty has evolved over last decades, with significant improvements in surgical techniques and graft types. In this narrative review, we aimed to explore the evolution of urethroplasty techniques for bulbar urethral strictures. To do this, the review is structured into three main sections: the Historical Background section highlights the seminal contribution from early pioneers to contemporary techniques, which re-gained momentum in reconstructive urology. Starting with the early techniques in the 19th and 20th centuries, we focused on the pioneering innovations of the 1990s, ultimately leading to the most recent tissue-preserving techniques. The second part presents a literature review comparing different graft types and critically evaluating surgical outcomes from multiple original articles and meta-analysis. Specifically, similar success rates were reported for oral and preputial grafts for the treatment of anterior urethral strictures, while long-term outcomes suggest graft deterioration over time. Furthermore, data on optimal surgical techniques remain limited. Lastly, Future Perspectives address ongoing innovations, including new graft and flap combinations for complex strictures, emphasizing the continuous refinement of less invasive, tissue-preserving techniques.

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Author information

Authors and Affiliations

  1. Unit of Urology, Urological Research Institute (URI), San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy

    Donato Cannoletta, Filippo Pederzoli, Andrea Salonia, Alberto Briganti, Francesco Montorsi & Marco Bandini

  2. Center for Genital Reconstructive Surgery, Cali, Colombia

    Christian Yepes

  3. Kulkarni Uro Surgery Institute, Pune, India

    Pankaj Joshi & Sanjay Kulkarni

Authors
  1. Donato Cannoletta
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  2. Filippo Pederzoli
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  5. Andrea Salonia
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  6. Alberto Briganti
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  7. Francesco Montorsi
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  8. Sanjay Kulkarni
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  9. Marco Bandini
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Contributions

Conception and design: MB, DC. Acquisition of data: DC, FP, MB. Analysis and interpretation of data: DC, MB. Drafting of the manuscript: DC, FP, MB, and CY. Critical revision of the manuscript for important intellectual content: PJ, AS, AB, SK, FM.

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Correspondence to Donato Cannoletta.

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Cannoletta, D., Pederzoli, F., Yepes, C. et al. Evolution and innovation in urethroplasty: a comprehensive narrative review of graft types and surgical techniques. Int J Impot Res (2025). https://doi.org/10.1038/s41443-025-01040-7

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