Single-Stage Reconstruction of Fossa Navicularis Strictures Using a "Sliding-T" Dorsal Inlay Urethroplasty With Buccal Mucosal Graft

Abstract

Objective: To describe a single-stage urethroplasty for fossa navicularis strictures using a "sliding-T" dorsal inlay technique with buccal mucosa. Strictures of the fossa navicularis are challenging. Endoscopic treatments typically offer only temporary relief and necessitate lifelong instrumentation. Reconstruction should provide an unobstructed urethra, slit-like meatus, preserve sexual function, and create a cosmetically appealing glans. The ideal urethroplasty technique has not yet been elucidated despite various described single-stage and multistaged approaches.

Methods: A retrospective review from January 2013 to May 2018 was performed to identify patients undergoing single-stage urethroplasty for fossa navicularis strictures. The primary outcome was urethroplasty success defined as the ability to easily pass a 16 Fr flexible cystoscope with a minimum of 12-month follow-up. Secondary outcome measures included 90-day complications, de novo erectile dysfunction, chordee, and patient satisfaction assessed at ~6-months postoperatively with the question, "Overall, are you satisfied with the result of your operation for urethral stricture?"

Results: Twenty-seven patients underwent reconstruction of fossa navicularis strictures using buccal mucosa with a "sliding-T" dorsal inlay urethroplasty technique. Stricture etiology was most commonly lichen sclerosus (70.4%; n = 19), iatrogenic (18.5%; n = 5), or idiopathic (11.1%; n = 3). Mean stricture length was 3.2 cm ± 1.2 [1-4] and mean patient age was 47.3 years [19-71]. Around 92.6% (n = 25) of patients failed prior endoscopic treatment while 7.4% (n = 2) failed prior urethroplasty. At a mean follow-up of 29.6 (12-60) months the success rate was 92.4% (n = 25). Both recurrences were managed successfully with meatotomy. 90-day complications (Clavien ≥2) occurred in 2 patients (7.4%) (surgical site infection treated with antibiotics). Functionally, 1 patient (3.7%) experienced de novo erectile dysfunction, 1 (3.7%) reported mild chordee, and 96.3% (26/27) of patients were satisfied with the outcome of surgery.

Conclusion: Reconstruction of fossa navicularis strictures using buccal mucosa with a single-stage "sliding-T" dorsal inlay technique provides satisfying anatomic and functional outcomes with a low rate of associated complications.