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This narrative review synthesizes current evidence regarding the structural, biological, and functional properties of FSB and evaluates its potential role in urological reconstruction. This narrative review was conducted using the PubMed, Google Scholar, and ScienceDirect databases with predefined keywords related to FSB\u2010derived biomaterials. Articles published from January 1, 2000, to December 31, 2025, were included. Eligible studies comprised original research, in vitro and in vivo experimental studies, and review articles. FSB is characterized by a high content of type I collagen, elastin, and glycosaminoglycans (GAGs), forming a well\u2010organized, hydrated, and mechanically resilient matrix that closely resembles native mammalian ECM. These properties support cellular adhesion, proliferation, and tissue regeneration, while also modulating inflammatory responses during wound healing. Preclinical studies demonstrate that decellularized FSB scaffolds exhibit favorable mechanical properties, biocompatibility, and the ability to promote constructive tissue remodeling. In addition, hydrolyzed derivatives, such as gelatin and collagen peptides, have demonstrated antioxidant and regenerative properties. However, intrinsic antimicrobial activity remains limited, often requiring additional functionalization to achieve clinically relevant antibacterial effects. Safety considerations, including potential allergenicity, variability in raw materials, and the risk of microbial contamination, underscore the importance of standardized processing and rigorous sterilization protocols. Composition, thermal stability, and gelation behavior vary substantially across fish species, indicating that species selection is a critical determinant of scaffold performance. Despite encouraging findings in experimental models, clinical translation in urological applications remains limited. Further research focusing on organ\u2010specific applications, long\u2010term safety, and optimized scaffold design is essential. 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