Reconstruction of resistant strictures of the fossa navicularis and meatus

Purpose: We evaluate the long-term efficacy of an integrated 1-stage approach for the reconstruction of resistant strictures of the fossa navicularis and meatus. Materials and Methods: 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. Results: 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. Conclusions: 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.