The modified Russell procedure: back to the future.

Urethral stricture repair, irrespective of the underlying etiology, has been a challenge for urologic surgeons for decades. However, surgical techniques are continually evolving and the overall success rates keep improving. Focusing on bulbar urethroplasty, the most common causes in the industrialized countries are external trauma and prior instrumentation. Short bulbar urethral strictures measuring <2.0– 2.5 cm in length are generally repaired by excision and end-to-end anastomosis with excellent results. Longer urethral strictures require open substitution urethroplasty, which is considered to be the gold standard treatment [1]. Urethral substitution procedures are achieved by using non-penile skin, penile skin (flaps or free grafts), or bladder or buccal mucosa. Although penile flaps are preferable in the pendulous urethra, most authors recommend grafts in the bulbar region [2]. Still under debate is the question of which tissue is particularly suitable for grafts. Alsikafi et al reported of an overall success rate of 84% (mean follow-up, 201 mo) and 87% (mean follow-up, 48 mo) for penile skin urethroplasty and buccal urethroplasty, respectively, without a significant difference. Gozzi et al treated almost 200 patients with genital and extragenital skin grafts and reported excellent results. On the other hand, Barbagli et al favored the buccal mucosa approach. In this study a success rate of 84% for buccal mucosa grafts was reported (mean follow-up, 42 mo), whereas penile skin graft had a failure rate of 27%; however, the mean