Ventral onlay graft techniques for urethroplasty.

Techniques of anterior urethroplasty have evolved over the last 40 years due to advances in tissue transfer techniques and the changing etiology of urethral stricture. The use of free grafts has come full circle from full thickness skin grafts to the current popularity of buccal mucosa grafts. Grafts fell out of favor due to poor results with full thickness skin grafts and the more widespread use of pedicle flaps. Although controversy still exists as to the appropriate use of flaps versus grafts, the evidence does not demonstrate an advantage in outcomes: overall success rates for grafts and flaps are similar (84.3 and 85.9% respectively). Nevertheless, grafting techniques are now considered first line therapy for the majority of strictures that cannot be excised and reanastomosed.