Surgical treatment of urethral stricture diseases is a continually evolving process, and there is renewed controversy over the best means of reconstructing the urethra, as the superiority of one technique over another has not yet been clearly determined . Notwithstanding, the use of tubes for urethral reconstruction has been abandoned, and end-to-end anastomosis and one-stage flap or graft urethroplasty have become the gold standard for the treatment of most urethral strictures  and . The future is at the door, and the tissue-engineering material for urethral reconstruction is already available. Several questions remain unanswered: How should we use this new grafting material? Should we use a tube or a graft? Should we use the onlay or the inlay technique? These questions are not negligible. The inlay graft technique designs a bed between two strips of original urethral mucosa where you might place the tissue-engineered material. When the new epithelial tissue–engineered material is closely placed between two urethral mucosa epithelial strips, how will the incorporation, the re-epithelisation, and the transformation of the transplant tissue into urethral mucosa result?
There is a grey zone between research and practice when we introduce innovation into the theatre, and although we do not want to suffocate surgical innovation, we also must not forget the safety of patients in the development of new operations. Because the safety and proof of concept in human beings are the main goals at this stage, we suggest that very few highly skilled surgical teams should be involved in tissue-engineered urethra reconstruction, and that their example should have a substantial effect on the diffusion of the technique. Few patients have to be recruited; they should be selected for specific characteristics and under a severe regulatory process.
We are looking at advances in urethral reconstruction with the hope that in the laboratory we might one day grow individually customised biologic urethra replacements for patients. Of course, such a revolutionary technique might sooner or later face cuts in expenditures on health care resulting from economic conditions, and we have a substantial way to go before such a dream is to be realised. However, there is room for hope.
Conflicts of interest
The authors have nothing to disclose.
-  S.B. Kulkarni, G. Barbagli, J.S. Kulkarni, G. Romano, M. Lazzeri. Posterior urethral stricture after pelvic fracture urethral distraction defects in developing and developed countries, and choice of surgical technique. J Urol. 2010;183:1049-1054 Crossref.
-  G. Barbagli, G. Morgia, M. Lazzeri. Retrospective outcome analysis of one-stage penile urethroplasty using a flap or graft in a homogeneous series of patients. BJU Int. 2008;102:853-860 Crossref.
-  G. Barbagli, M. Lazzeri. Surgical treatment of anterior urethral stricture diseases: brief overview. Int Braz J Urol. 2007;33:461-469
© 2011 Published by Elsevier B.V.