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. 2022 Jun;40(6):1523-1528.
doi: 10.1007/s00345-022-03994-5. Epub 2022 Apr 6.

Transurethral reconstruction of fossa navicularis strictures with dorsal inlay buccal mucosa graft urethroplasty

M Ryan Farrell  1 , Jack G Campbell  1 , Lawrence Zhang  1 , Samuel Nowicki  1 , Alex J Vanni  2
Affiliations

Transurethral reconstruction of fossa navicularis strictures with dorsal inlay buccal mucosa graft urethroplasty

M Ryan Farrell et al. World J Urol. 2022 Jun.

Abstract

Purpose: To describe a single stage, glans-sparing urethroplasty technique for fossa navicularis strictures using a transurethral dorsal inlay buccal mucosa graft.

Methods: We conducted a retrospective review of a prospectively maintained urethral stricture database to identify all fossa navicularis strictures reconstructed with a single stage, transurethral dorsal inlay buccal mucosa graft urethroplasty (5/2015-6/2020). Primary outcomes were anatomic success, defined as the ability to pass a 17 Fr flexible cystoscope, and functional success, defined as the lack of obstructive voiding symptoms and no need for further procedures. Secondary outcomes were postoperative complications and patient satisfaction.

Results: Sixteen patients were included. Mean age was 63.1 years (43.9-75.6) and mean stricture length was 1.7 cm (1.4-2.0). Stricture etiology included internal trauma (62.5%), idiopathic (25.0%), and lichen sclerosus (12.5%). Prior endoscopic procedures were done in 75% of patients. Over a median follow-up of 28.8 months (IQR 17.6-38.0), anatomic success was 15/16 (93.8%) and functional success was 16/16 (100%). The single anatomic recurrence was at 4.2 months postoperatively. No additional procedures were required. Urinary tract infection occurred in 25% (4/16). There were no instances of de novo erectile dysfunction, chordee, or wound infection. All patients would recommend urethroplasty to others and all patients were either very satisfied (83.3%) or satisfied (16.7%) with the procedure. Penile sensitivity was unchanged in 83.3%, increased in 8.3% and decreased in 8.3%.

Conclusion: Transurethral dorsal inlay buccal mucosa graft urethroplasty is a viable option for reconstruction of fossa navicularis strictures that avoids splitting the glans and results in excellent cosmesis.

Keywords: Anterior urethral stricture; Buccal mucosa; Urethra; Urethral stricture.

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