reconstruction of long tracts of restricted urethra can even require two stage procedures, whereas single stage operations can be carried out only by means of flaps as penile foreskin or grafts as buccal mucosa, not completely troublefree for uptake and transposition. Nowadays tissue engineering simplifies this surgery using porcine acellular matrix obtained from pig Small Intestine Submucosa.

Operation steps are: coronal incision and dartos stripping extendable to perineum-scrotal region, if required. The urethra is freed, rotated of 180 ° and here opened long all the stenotic tract were the matrix graft will be sutured. After the reconstruction,urethra is then derotated in dorsal position, to be reinforced by the contact with corpora cavernosa, to prevent pouching. Since 1999 underwent to this procedure 18 men and 2 women, affected with severe long relapsed strictures hardly treatable by traditional techniques. Since 2002 we stopped our experience for outcomes evaluation. More recently we moved on with 5 other operations but avoiding urethral freeing, 180 ° rotation, dorsal matrix suture and derotation.

outcomes prove effective under morphological and functional assessment with improvement in IPSS, QoL and uroflowmetry by both techniques even if ventral grafting was far easier and no pouching were observed. Urethroscopy confirmed a satisfactory urethral restoration.

restricted number of patients and the medium term follow up (5 years) allow us to report only preliminary considerations on the procedures; but just the preliminary effective and safe results suggest to continue with this experience, especially with the ventral matrix procedure.