Abstract
Introduction: In the context of urethroplasty, epidemiological data show that urethral trauma accounts for approximately 4.5% of all genitourinary traumas. Most urethral traumas, both blunt and penetrating, result in complete urethral rupture, while the remaining 1/3 result in at least a partial urethral laceration. Urethroplasty remains a significant challenge in urethral and penile reconstruction, and the use of robotics and artificial intelligence is a significant tool for improving urethroplasty. Objective: This study aimed to present the main surgical approaches for urethroplasty after trauma or subsequent comorbidities, highlighting the use of robotic surgery and artificial intelligence to optimize surgical techniques. Methods: The PRISMA Platform systematic review rules were followed. The research was carried out from February to April 2026 in the Scopus, Embase, PubMed, Science Direct, SciELO, and Google Scholar databases. The quality of the studies was based on the GRADE instrument, and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 117 articles were found, and 35 articles were evaluated in full, and 12 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 25 studies with a high risk of bias and 27 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X2=81.1%>50%. It was concluded that, regardless of the urethral injury pattern and treatment options, well-planned, rigorous follow-up with a urologist is of utmost importance for accurate assessment of outcomes and proper management of complications. Patient characteristics and needs should be considered before developing a surgical plan. The tube-in-tube technique is the first choice for single-stage penile and urethral reconstruction for thinner patients. For other patients, a different flap can be used as a substitute for urethral reconstruction. Superficial circumflex iliac artery, pudendal-thigh, and pedicled scrotal flaps can be used to reconstruct the urethra. The tubularized superficial circumflex iliac artery flap and the pudendal-thigh flap are reliable, simple, and suitable for revision urethroplasty. Finally, buccal mucosal grafts with auxiliary maneuvers, such as flap interposition or transfer of adjacent tissue, in robotic reconstruction of the lower urinary tract are durable, safe, and comparable to open surgical approaches, especially when aided by the use of artificial intelligence to enhance urethroplasty.