Buccal mucosa grafts (BMG) have become the standard for complex urethral reconstruction due to unique regenerative properties, including rapid re-epithelialization, minimal inflammation, and tightly controlled fibroblast action that results in “scarless healing”. These characteristics reflect fetal-like wound healing phenotypes with distinct fibroblast subpopulations and favorable inflammatory profiles. BMG have applications across the genitourinary tract from renal pelvis to external genitalia. Emerging technologies—tissue-engineered oral mucosal substitutes, extracellular vesicles, and organoid systems—offer future possibilities for patients who need large reconstructions. However, clinical translation requires manufacturing standardization and cost reduction. This review outlines BMG biology and highlights future urologic applications.