Transmeatal urethral surgery (TraMUS): technique and one-year outcomes in the management of penile urethral strictures

Abstract

Purpose: To describe the technique and early outcomes of transmeatal urethroplasty for penile urethral strictures.

Methods: We retrospectively reviewed a database of patients who underwent transmeatal urethral surgery for penile urethral strictures using an extended Nikolavsky technique with buccal graft at a single institution. The study includes patients with lichen sclerosis and hypospadias and outlines a comprehensive surgical and postoperative care protocol.

Results: 13 patients were treated for penile strictures and included in this study. The etiology of stricture included iatrogenic (n = 6), lichen sclerosis (n = 2), and hypospadias (n = 3). The average graft length was 6.5 cm (range 3-15 cm). Two patients were lost to follow up at 4 months and 8 months respectively. Median follow up duration was 14 months (range 11-28 months). Of the 11 patients with data at one year, there was one failure, which occurred at 3 months (91% primary success rate). Only 1 patient (9%) developed de novo incontinence following the procedure. There were no other reported complications directly related to the procedure.

Conclusions: Penile urethral strictures present significant challenges in urological practice due to their complex etiology and high complication rate. These strictures frequently recur after traditional treatments leading to the recommendation to offer urethroplasty at diagnosis. We describe a novel, transmeatal technique for managing penile urethral strictures, aimed at reducing the risks associated with conventional surgery, which was successful in 91% of patients at one year. Further studies are necessary to confirm the long-term efficacy and compare this approach to traditional surgical methods.

Keywords: Buccal mucosal graft; Endoscopic; Urethral stricture; Urethroplasty.