Urethral strictures have been a reconstructive dilemma for many years due to the limited availability of tissue substitutes and incidence of recurrence. Buccal mucosal grafts have been a favored material in instances where penile skin is unavailable due to its durability and excellent graft survival. Recently collagen based matrices derived from the bladder have been used successfully in patients with stricture disease and hypospadias. We performed a randomized comparative study to assess the outcome of the acellular bladder matrix compared to buccal mucosa in patients with complex urethral strictures.