Urethral strictures, caused by fibrotic narrowing of the urethral lumen, lead to micturition dysfunction and remain a significant urological challenge. They can result from trauma, idiopathic factors, or infections, with trauma being the leading cause, accounting for 58% of cases. Common traumatic causes include catheter-related injuries and traffic accidents. To restore urethral patency , various grafting techniques are available for urethral stricture reconstruction.

A systematic review and meta-analysis were performed according to PRISMA guidelines, identifying studies on urethral stricture management using various grafts (buccal, preputial, and labial) with outcomes including Qmax, IIEF, and IPSS.

Nine studies were included. Overall, graft-based reconstruction significantly improved Qmax (MD: 15.29 mL/sec; 95% CI: 14.83–15.75 [fixed-effects]; 15.25 mL/sec; 95% CI: 12.82–17.68 [random-effects]) with sustained improvements up to 12 months, despite high heterogeneity (I² = 95.0%, p < 0.0001). Subgroup analysis revealed similar efficacy between buccal and preputial grafts, with a significant reduction in IPSS (MD: -12.30; 95% CI: -12.80 to -11.79, I² = 0%). In contrast, IIEF scores showed no significant postoperative change (MD: -0.69; 95% CI: -1.60 to 0.22, I² = 86.9%).

Graft-based urethral reconstruction markedly improves urinary flow and alleviates symptoms, enhancing quality of life without compromising erectile function. Buccal mucosal grafts are favored for their reliability and durability in managing complex strictures, underscoring the need for standardized surgical techniques and outcome measures.