Objective To explore the application effect of acellular allogeneic dermis in urethral reconstruction and penile plastic surgery. Methods A total of 88 patients who underwent urethral reconstruction or penile plastic surgery in Sanming Second Hospital from January 2018 to March 2025 were selected. According to different repair materials, they were divided into the control group and the observation group, with 44 patients in each group. The control group was repaired with autologous oral mucosa, and the observation group was repaired with acellular allogeneic dermis. The operation-related indicators, complication rate and satisfaction were compared between the two groups. Results The intraoperative blood loss in the observation group was less than that in the control group, and the operation time was shorter than that in the control group (P<0.05). The incidence of complications in the observation group (9.09%) was lower than that in the control group (29.55%) (P<0.05). The satisfaction rate of the observation group (95.45%) was higher than that of the control group (81.82%) (P<0.05). Conclusion The application of acellular allogeneic dermis in urethral reconstruction and penile plastic surgery can effectively shorten operation time, reduce intraoperative blood loss, lower the incidence of complications, and improve patient satisfaction.