Urethral Reconstruction

Urethral reconstruction encompasses a broad spectrum of surgical procedures used to restore luminal continuity and adequate caliber to the urethra following stricture, trauma, lichen sclerosus, failed prior surgery, or congenital anomaly. Techniques range from simple endoscopic dilation to highly complex multi-stage flap reconstructions using oral mucosa, penile skin, gracilis muscle, or bowel. This database catalogs both male and female urethral reconstruction techniques with links to individual procedure pages.

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General Principles

• Principles of Urethral ReconstructionStricture staging, scar excision, tension-free anastomosis, graft-bed vascularity, oral mucosa selection, vessel-sparing techniques, staged repair, and early referral for definitive reconstruction.

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Technique Database

Male Urethral Reconstruction

All LocationsAnyBulbarFossa Navicularis / MeatalPanurethralPenilePosterior / PFUI

46 of 46 techniques

Technique	Eponym / Origin	Location	Notes
Dorsal Onlay OMG Urethroplasty	Barbagli, 1996	Bulbar	Graft placed on dorsal urethral surface against tunica albuginea for optimal take.
Ventral Onlay OMG Urethroplasty	Morey & McAninch, 1996	Bulbar	Graft placed ventrally on the spongiosum; no urethral mobilization required.
Excision and Primary Anastomosis (EPA) Anastomotic urethroplasty	Turner-Warwick, 1960	Bulbar	Gold standard for short bulbar strictures ≤2 cm; requires tension-free spatulated anastomosis.
Non-Transecting Bulbar Urethroplasty	Andrich & Mundy, 2012	Bulbar	Preserves spongiosal vascularity by avoiding complete urethral transection.
Jordan Vessel-Sparing EPA	Jordan, 2007	Bulbar	Preserves central bulbar arteries during anastomotic repair to reduce erectile risk.
Augmented Anastomotic Urethroplasty	Guralnick & Webster, 2001	Bulbar	Combines EPA with graft augmentation at anastomosis to manage longer strictures.
Joshi Step / MsANTA Muscle-sparing Anastomotic	Joshi PM, 2022	Bulbar	Preserves bulbospongiosus muscle during EPA; reduces perineal morbidity.
MANTA Muscle-sparing ANasTomotic Anastomosis	Marks et al., 2023	Bulbar	Bulbospongiosus reflected rather than divided; shares principles with MsANTA.
Asopa Dorsal Inlay OMG	Asopa HS, 2001	Bulbar	Dorsal graft placement via ventral urethrotomy without full urethral mobilization.
Dorsal Circumcision Approach	Barbagli et al., 2004	Penile	Degloving via circumcising incision for wide-field access to penile urethra.
Penile Inversion Urethroplasty	Turner-Warwick, 1968	Penile	Penis inverted through perineal incision for direct penile urethral access.
Johanson Two-Stage Urethroplasty	Johanson B, 1953	Panurethral	Stage 1: marsupialize urethra; Stage 2: tubularize after maturation. Historic reference technique.
Kulkarni Two-Stage Urethroplasty	Kulkarni SB, 2009	Penile	BMG or skin graft at Stage 1 creates a wide plate before tubularization; favored in lichen sclerosus.
Kulkarni One-Stage Panurethral Urethroplasty	Kulkarni SB, 2009	Panurethral	Single perineal incision reconstructs entire urethra with BMG; landmark LS technique.
McAninch Transverse Circular Penile Skin Flap	McAninch JW, 1993	Penile	Circular penile skin island on dorsal pedicle for long-segment penile or bulbar repair.
Orandi Flap Longitudinal Ventral Penile Skin Flap	Orandi A, 1968	Penile	Longitudinal ventral penile skin island on lateral pedicle; classic one-stage penile repair.
Modified Orandi Flap	Variation of Orandi, 1968	Penile	Variation of the Orandi flap with modified pedicle design for improved reach or coverage.
Turner-Warwick Longitudinal Ventral Penile Flap	Turner-Warwick RT, 1960	Penile	Longitudinal ventral penile skin with ventral pedicle; foundational fasciocutaneous flap technique.
Quartey 'Q' Flap	Quartey JKM, 1983	Penile	Quadrilateral penile skin island on subcutaneous pedicle for onlay or tube repair.
Pedicled Prepucial Tube Urethroplasty	Hodgson NB, 1970	Penile	Tubularized inner prepucial skin on dartos pedicle; requires abundant non-diseased foreskin.
Single-Stage Prepucial Flap Urethroplasty	Duckett JW, 1980	Penile	Prepucial onlay flap avoiding tubularization; lower complication rate than tube.
Propeller Flap Urethroplasty	Teo TC, 2010	Any	Perforator-based fasciocutaneous flap rotating on single vessel; useful in salvage cases.
Singapore Flap Urethroplasty	Wee JT & Joseph VT, 1989	Panurethral	Pedicled medial thigh fasciocutaneous flap; useful for perineal urethral defects.
Laminated Gracilis Flap Urethroplasty	Zinman L, 2002	Any	Skin graft or BMG laminated onto gracilis muscle; for radiation-damaged or complex defects.
Prelaminated BMG-Gracilis Flap	Nikolavsky D, 2015	Any	Two-stage salvage: BMG prelaminated onto gracilis; for radiation necrosis, recurrent fistulae.
Oral Mucosa Flap (Lingual)	Simonato A, 2006	Any	Tongue mucosal harvest when buccal sites are exhausted; similar histology and take rates.
Enterourethroplasty	Mundy & Andrich, 2010	Any	Bowel segment (ileum) used for pan-urethral obliteration; last-resort reconstruction.
Muscle-Sparing Urethroplasty	Andrich & Mundy, 2012	Bulbar	Bulbospongiosus reflected rather than divided; reduces pain and preserves function.
Liquid / Minced Buccal Mucosal Graft	Emerging technique, ~2019	Any	Investigational: minced BMG fragments delivered endoscopically. Not yet routine clinical use.
Endoscopic Urethroplasty	Emerging technique, ~2018	Any	Minimally invasive graft delivery via robotic/endoscopic approach; emerging technique.
Drug-Coated Balloon Therapy	Elliott et al. (ROBUST III), 2022	Bulbar	Paclitaxel-coated balloon concept; Optilume has ROBUST III support for recurrent bulbar strictures, while ureteral DCB use remains investigational.
DVIU and Urethral Dilation DVIU / Dilation	Sachse H, 1974	Bulbar	Interchangeable first-line endoscopic options for selected short bulbar strictures; repeated use after failure performs poorly.
Core-Through Urethrotomy	Carr LK & Webster GD, 1996	Posterior / PFUI	Binocular endoscopic core of obliterated PFUI stricture; bridging procedure before open repair.
Meatotomy	—	Fossa Navicularis / Meatal	Simple incision of meatal stenosis; rapid outpatient procedure under local anesthesia.
Ventral Onlay Glanuloplasty	Morey AF, 2001	Fossa Navicularis / Meatal	BMG onlay to glans/fossa navicularis; preferred for lichen sclerosus meatal stenosis.
Y-V Glans Flap	Cohney BC, 1963	Fossa Navicularis / Meatal	Local flap advancement in Y-to-V pattern; effective for mild meatal stenosis.
Sliding T Dorsal Inlay	Morey AF, 2005	Fossa Navicularis / Meatal	T-shaped glans flap inlaid dorsally into fossa navicularis; avoids free graft.
Transmeatal OMG Ventral Inlay (Nikolavsky)	Nikolavsky D, 2016	Fossa Navicularis / Meatal	Transmeatal endoscopic BMG placement without external glans incisions.
Fasciocutaneous Ventral Penile Transverse Island Flap	Jordan GH & Schlossberg SM, 1987	Fossa Navicularis / Meatal	Transverse penile skin island on dartos pedicle for distal urethral/meatal reconstruction.
Penile Skin Flap Urethroplasty (Fossa Navicularis)	Jordan GH, 1999	Fossa Navicularis / Meatal	Pedicled penile shaft skin for distal urethral reconstruction; use only non-diseased skin.
Posterior Urethroplasty / PFUI Repair	Turner-Warwick RT, 1960	Posterior / PFUI	Deferred perineal anastomotic repair for pelvic fracture distraction defects; >90% success.
Blandy Perineal Urethrostomy	Blandy JP, 1968	Panurethral	Permanent perineal stoma for complex recurrent stricture; patient must sit to void.
7-Flap Perineal Urethrostomy	French, Hudak & Morey, 2011	Panurethral	Seven-flap design creates wide, contracture-resistant permanent perineal stoma.
Lotus Petal Flap Urethroplasty	Yii NW & Niranjan NS, 1996	Panurethral	Bilateral pedicled labia majora/inner thigh flaps for complex perineal reconstruction.
Scrotal Dropback Urethroplasty	Turner-Warwick RT, 1960	Panurethral	Scrotum mobilized inferiorly for access to penoscrotal junction in complex panurethral repair.
Bladder Neck Reconstruction	Wessells H & McAninch JW, 1997	Posterior / PFUI	Addresses post-prostatectomy or radiation-induced bladder neck contracture.

Female Urethral Reconstruction

All LocationsAnyPosterior / PFUI

6 of 6 techniques

Technique	Eponym / Origin	Location	Notes
Female Urethral Dilation	—	Any	Calibrated dilation for female urethral stenosis; high recurrence, temporizing measure.
Female Dorsal Onlay Urethroplasty	Sharma GK et al., 2010	Any	Transvaginal dorsal BMG onlay; preferred approach for female urethral stricture.
Female Vaginal Flap Urethroplasty (Blandy)	Schwender et al., 2006	Any	U-shaped anterior vaginal wall flap advanced to augment female urethra; no free graft needed.
Urethral Diverticulum Repair	Young HH, 1938	Any	Transvaginal excision of diverticular sac with multilayer closure and Martius flap interposition.
Urethral Prolapse Repair	—	Any	Circumferential excision of prolapsed urethral mucosa with mucocutaneous reapproximation for symptomatic, thrombosed, necrotic, or refractory urethral prolapse.
Female Bladder Neck Reconstruction	Blaivas JG, 1989	Posterior / PFUI	Addresses post-cystectomy or radiation-induced female bladder neck contracture.