An open urethroplasty is more complex and may be necessary for longer strictures. This procedure involves an incision between the scrotum and rectum. The narrowed area of the urethra is removed and the remaining urethra is reconnected (anastamosis). When the stricture is too long, a tissue graft, most commonly from the inside of the mouth (buccal), may need to be used to increase the length of the urethra. Due to the complexity of this operation, there are times when the surgeon may recommend that the urethroplasty is done with a staged approach, meaning that more than one surgery will be required.