Outcomes of a urethroplasty algorithm for fossa navicularis strictures

Abstract

Introduction: There is no standardized treatment algorithm for isolated fossa navicularis strictures and treatment modality often falls to surgeon preference. We evaluated the outcomes of a standardized algorithm for fossa navicularis strictures based on stricture etiology, lumen size, and glans size to minimize the number of patients requiring a two-stage urethral reconstruction.

Materials and methods: We retrospectively reviewed a prospectively maintained urethral reconstruction database by a single surgeon from 2011-2018. A treatment algorithm was applied and patients underwent one of three treatment modalities: a two-stage buccal mucosa graft (BMG), a single-stage dorsal inlay BMG, or a single-stage dorsal inlay BMG and ventral fasciocutaneous flap repair. Stricture recurrence was measured by inability to pass 17 Fr flexible cystoscope. Patient sexual function and satisfaction were evaluated by the International Index of Erectile Function (IIEF) and a patient perception questionnaire.

Results: Forty-two patients met inclusion criteria with a mean follow up of 12.3 months. Urethroplasty success rate was 92%. There was no change in IIEF scores pre and postoperatively between single stage BMG, two-stage BMG, and combined BMG and flap repairs (+ 0.4; p = 0.88, 0.0; p = 1.00, and -0.3; p = 0.74). Ninety-four percent of patients reported being very satisfied or satisfied with their reconstruction.

Conclusion: An algorithmic approach to the treatment of fossa navicularis strictures is an appropriate method for reconstructive intervention with a high rate of success and patient satisfaction with no significant impact on erectile function.