Reconstruction of resistant strictures of the fossa navicularis and meatus.

Abstract

We evaluate the long-term efficacy of an integrated 1-stage approach for the reconstruction of resistant strictures of the fossa navicularis and meatus. In 19 men with resistant glanular urethral strictures of varied origin reconstruction was tailored to the individual characteristics of the urethral stricture and glans. Urethral reconstruction was performed with a ventral transverse island fasciocutaneous penile flap in 16 cases, resection and primary end-to-end anastomosis in 2, and a buccal mucosal graft in 1. The glanuloplasty was completed as a glans cap in 15 patients and as glans wings in 4. In the latter group the glans was significantly scarred from the causative process and previous failed procedures. The patients were followed for a mean of 42.7 months. Transient urinary splaying and mild glans torsion were observed postoperatively but resolved within 8 weeks. Overall, a durable, functional and cosmetic result was achieved in 18 patients (94.7%), and only 1 had an anastomotic stricture that required reoperation. Although the management of resistant glanular urethral strictures can be difficult, the appropriate reconstructive techniques can permanently correct these strictures. We describe a logical 1-stage approach to reconstructing the fossa navicularis and meatus, allowing a functionally successful and cosmetically appealing long-term outcome.