To evaluate the role of the tissue expansion concept in reconstructive urology, the contemporary literature was reviewed, together with our own results with tissue expansion. The principle of tissue expansion has been applied in cases of bladder augmentation, ureteral dilation for the generation of indigenous tissue and subsequent ureterocystoplasties, ureteral elongation, and dilation of the renal pelvis, producing native tissue for the reconstruction of defects or strictures of the upper ureter. Even though the exact mechanism of action of mechanical strain in different tissues is not known, tissue expansion is a well-accepted technique that can amplify the armamentarium of reconstructive urologists for the management of defects along the urinary tract.