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Purpose of review Urethrotomy remains the first-line therapy in the treatment of a urethral stricture despite data showing no real chance of a cure after repeated urethrotomies. An anastomotic or an augmentation urethroplasty using oral mucosa can be offered to patients following failed urethrotomy. The potential for a tissue engineered solution as an alternative to native tissue has been explored in recent years and is reviewed in this article. Recent findings More than 80 preclinical studies have investigated a tissue-engineered approach for urethral reconstruction mostly using decellularized natural scaffolds derived from natural extracellular matrix with or without cell seeding. The animal models used in preclinical testing are not representative of disease processes seen with strictures in man. The available clinical studies are based on small noncontrolled series. Summary There is a potential role for tissue engineering to provide a material for substitution urethroplasty and work has demonstrated this. Further work will require a rigorous basic science programme and adequate evaluation of the material prior to its introduction into clinical practice. The research with tissue engineering applied to the urethra has not yet been resulted in a widely available material for clinical use that approaches the efficacy seen with the use of autologous grafts.

Urethrotomy remains the first-line therapy in the treatment of a urethral stricture despite data showing no real chance of a cure after repeated urethroplasties. An anastomotic or an augmentation urethroplasty with oral mucosa should be offered to patients with a failed urethrotomy. The availability of grafts can be a concern for both patients and surgeons. The potential for a tissue-engineered solution has been explored in recent years and is explored in this article.More than 80 preclinical studies have investigated a tissue-engineered approach for urethral reconstruction mostly using decellularized natural scaffolds with or without cell seeding. The animal models used in preclinical testing are not representative of disease processes seen with strictures in man. The available clinical studies were of small sample size and lacked control groups. The choice of biomaterial were mostly acellular matrices derived from natural extracellular matrix. The reported success rates in the pilot clinical studies were highly variable.The research with tissue engineering of the urethra has not yet been translated into a clinically available material. This is an area where much more research is needed and we would conclude that it is an area of unmet clinical need where users of tissue-engineered urethra in the future need to carry out a rigorous basic science programme and need to be cautious in drawing conclusions based on initial experience and report on long-term clinical results.

Purpose of review Female urethral stricture disease is increasingly recognized as an uncommon but important cause of lower urinary tract symptoms in women, which is amenable to surgical treatment. Several new reconstructive techniques have recently been described. The purpose of this review is to summarize the past literature with a focus on more recent contributions. Recent findings Several new studies have recently been published investigating previously described reconstructive techniques including vaginal flap urethroplasty using the ventral approach, ventral labial graft, dorsal vaginal graft and dorsal buccal mucosal graft urethroplasty. Success rates, variably defined, ranged from 57.1 to 100% in these new contributions. No incidences of stress urinary incontinence were described. There continues to be lack of robust evidence to advocate one technique of urethroplasty for female urethral stricture disease over another, surgeon experience is likely to be an important factor. Summary Urethroplasty using a flap or graft augmentation is a feasible treatment for female urethral strictures with good reported success rates and a minimal risk of stress of incontinence. Further studies are required to define the optimal technique and approach.

The use of synthetic slings for the treatment of male stress urinary incontinence (SUI) has increased over the last decade. Several sling designs and techniques are now available. The purpose of this review is to summarize the past literature with a focus on more recent contributions.The recent literature focusses on the retrourethral transobturator sling (RTS), which is considered noncompressive. MRI of patients undergoing RTS has shown an increase in membranous urethral length and elevation of the external urethral sphincter, whereas a recent large series demonstrated approximately a half and a quarter of patients are cured or improved, respectively, at 1 year after RTS implantation, with results sustained through to 3 years. Serious complications such as urethral erosion occur rarely.The available evidence suggests that male slings can be an efficacious and well tolerated treatment modality for men with SUI. Nevertheless, important questions remain with regard to the durability of repair, device safety and comparative efficacy. The mechanism of action and factors that predict failure remain to be fully elucidated.