This is a state of the art lecture on the phathophysiology of healing after treatment of anterior urethral strictures. The principles of wound healing, grafting and pediculated tissue transfer are described and applicated to the different treatment modalities: endoscopic incision, stents, end-to-end anastomosis, free grafts either ventral or dorsal and different pediculated grafts of penile skin. The rules of wound healing form the base for the best treatment choice. Multiple techniques should be mastered to obtain the best result.Randomised clinical trials on different techniques, to cure urethral strictures, do not exist. Only small descriptive series of different techniques are available. So the highest level of evidence to make any recommendation is not higher than level 3. However like in other types of surgery, the operative techniques depend on wound healing of which the pathophysiological principles are known since a long time. There is also (old) literature on experimental urethral surgery, which learns us what can be worse or better.
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