Lee C. Zhao, MD, MS, Editor

Standardized definitions of success are important for evaluation of surgical technique: we can only improve what we measure. This issue of Urologic Clinics begins with a declaration on how to define successful surgery, and the standardized follow-up after urethral reconstruction. The ideal follow-up regimen must be weighed against the cost, and the next article provides a discussion of cost-effectiveness.

Progress in the treatment of urethral strictures involves making surgery less morbid and more efficacious. Although less efficacious, endoscopy is the least morbid treatment and is often the preferred initial step of therapy. If urethroplasty is chosen, one must select between anastomotic and substitution urethroplasty, and for substitution urethroplasty, which grafts to use. Sexual dysfunction after urethroplasty can be a significant source of patient dissatisfaction. One surgical innovation to reduce the risk of sexual dysfunction is the approach of nontransecting urethroplasty.

There are several challenging problems in urethral reconstruction that warrant detailed discussion. Panurethral strictures, lichen sclerosis, and radiation-induced strictures can all reduce the success rate of reconstruction. Another complicated topic is the management of urinary incontinence in patients with urethral strictures, as artificial urinary sphincter placement may result in urethral erosions, and urethral strictures may arise after urethral erosions. A detailed understanding of the reasons for failure of initial reconstruction is important for urethroplasty after complications of hypospadias surgery and for strictures in transgender patients. While buccal mucosa has become the graft material of choice in urethroplasty, patients who have undergone multiple reconstructive procedures require alternative sources of grafts.

I am deeply grateful to the world experts in reconstructive urology who took time away from their busy clinical practices to contribute these insightful articles.