Fossa Navicularis and Meatal Reconstruction

Abstract

The correction of strictures involving the fossa navicularis and meatus poses a distinct challenge. Unlike surgical repair of strictures involving other urethral segments where the primary concern is restoration of urethral patency, management of glanular urethral strictures also requires particular attention to cosmesis. Various options are available, the choice of which depends on the etiology and characteristics of the stricture, prior failed procedures, the patient’s expectations, and the surgeon’s operative familiarity and preference. No single technique is applicable to all strictures. In general, minimally invasive procedures are usually palliative, whereas reconstructive procedures should be performed with a curative intent. Paramount to the success of any reconstructive procedure is the careful selection of non-diseased tissue for urethral substitution. If the penile skin is healthy and the glans is not extensively involved with LSA, our preferred urethral substitute is the fasciocutaneous ventral penile transverse island flap. In cases of extensive LSA or penile scarring, extragenital tissue transfer techniques should be considered, preferably in one stage, using the versatile buccal mucosal graft. Equally important is the choice of glanuloplasty. Where possible, a glans-cap repair is preferred because of the limited dissection required with this relatively simple technique.