Urethral strictures can result from various etiologies, including iatrogenic, traumatic, idiopathic, and infectious causes. Treatment options include urethral dilation, optical urethrotomy, and urethroplasty, which may be performed using an anastomotic or substitution approach. Patients with recurrent or complex strictures often require alternative reconstructive techniques. We present a case of a 24-year-old male with a traumatic posterior urethral total disruption following a traffic accident, who underwent robotic-assisted urethroplasty using a lower lip mucosal graft.

The patient initially underwent early endoscopic realignment with an indwelling Foley catheter. After three months, he developed persistent urinary retention. Cystoscopy revealed a blind end at the bulbar urethra. He underwent two sessions of optical urethrotomy, but refractory urinary retention persisted. Given the complexity of his condition, robotic-assisted urethroplasty with a lower lip mucosal graft was planned. Under cystoscopic and transrectal ultrasound (TRUS) guidance, the stricture site at the membranous urethra was identified. A longitudinal incision was made, and a precise lateral incision was performed using a robotic system to accommodate the onlay lower lip mucosal graft, which was then sutured into place.

The Foley catheter was removed one month postoperatively. According to the uroflowmetry, voiding cystourethrogram (VCUG) and cystoscope vision, the patient was able to void with a good urinary stream without significant post-void residual volume. No complications related to the graft or the robotic-assisted procedure were observed during follow-up.

Robotic-assisted urethroplasty with a lower lip mucosal graft is an effective option for managing complex urethral strictures, particularly in patients with a history of multiple failed urethral interventions and long-segment stenosis ay membrane urethra. The lower lip mucosa offers a reliable graft source with excellent tissue characteristics, demonstrating promising outcomes for reconstructive urethral surgery.