Fossa Navicularis Reconstruction: Impact of Stricture Length on Outcomes and Assessment of Extended Meatotomy (First Stage Johanson) Maneuver

Purpose: We evaluated the significance of stricture length and severity on the outcome of fossa navicularis reconstruction. We also determined the efficacy and usefulness of an extended meatotomy (first stage Johanson) salvage maneuver in refractory cases. Materials and Methods: Our 7-year experience with the surgical management of distal urethral strictures involving the fossa navicularis was reviewed. Stricture length, reconstructive method and outcomes were assessed in 40 consecutive cases performed at our institution from 1997 to 2003. Men undergoing flap or graft onlay reconstruction were divided into group 1-short, isolated fossa navicularis strictures (2.5 cm or less) and group 2-long pendulous urethral strictures (greater than 2.5 cm) extending into the fossa navicularis. Men treated with extended meatotomy for complex and/or reoperative distal strictures comprised group 3. Results: Average followup was 52 months (range 28 to 81). The majority of men with short isolated fossa navicularis strictures (group 1 average length 2.2 cm, range 1.5 to 2.5) had successful onlay reconstruction (10 of 11, 91%). Those with longer strictures (group 2 average length 7.4 cm, range 4 to 16) had significantly poorer outcomes with onlay reconstruction (7 of 13, 54%, p <0.05). Failures presented in a delayed manner with recurrent stenosis of the distal segment. Extended meatotomy (group 3) proved to be successful in 14 of 16 men (87%) with complex or reoperative strictures. Conclusions: Stricture length influences the outcome of distal urethroplasty. Onlay repair via a penile fasciocutaneous flap technique is reliable for short perimeatal strictures, but is less well suited for longer distal strictures. Extended meatotomy appears to be a highly effective salvage maneuver for complicated strictures of the fossa navicularis.