Distal urethroplasty for isolated fossa navicularis and meatal strictures

Meeks, Joshua J.; Barbagli, Guido; Mehdiratta, Nitin; Granieri, Michael A.; Gonzalez, Chris M.

doi:10.1111/j.1464-410x.2011.10248.x

Cited by 38 publications

(28 citation statements)

References 15 publications

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“…17,18 Since there is currently no reconstruction center that specifically treats complex urethral stricture disease in Taiwan, in this study we also tried to propose a practical algorithm for reference. Only two patients, including the one undergoing cutaneous urethrostomy, failed to regain the ability to urinate through the urethra by using this algorithm in our hospital.…”

Section: Discussionmentioning

confidence: 99%

Management of complex urethral stricture disease: Algorithm and experience from a single institute

Shau

Kao

et al. 2015

Urological Science

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a b s t r a c tObjective: There are currently no practical guidelines regarding recurrent or complex urethral strictures in Taiwan. Furthermore a specific urological reconstruction center focusing on urethroplasties in this area is currently unavailable. In this study we aim to share the experience of our institute according to an algorithm for this disease entity. Methods: From December 2007 to October 2013, adult males with complex urethral strictures were enrolled. Six different surgical techniques were used for treatment. Clinical features and outcomes were analyzed through a retrospective chart review. Results: The mean age was 39 years, with a mean follow-up period of 42 months (range, 5e76 months). An average of three sessions of previous treatments was noted. The overall primary success, requiring no further intervention, was 46%. Permanent failure occurred in one patient (2.6%). The primary success for urethroplasty in distal, penile, bulbar, posterior urethra, and in stricture with hypospadias was 100%, 40%, 83%, 29%, and 60%, respectively. From the perspective of procedure type, anterior anastomotic urethroplasty (80%) and skin-based flaps (75%) resulted in the highest success rate. Following anterior or posterior buccal mucosal graft-augmented urethroplasties, 40% of patients received additional shortterm dilatations or urethrotomies. Conclusion: Complex urethral strictures can be managed by a variety of surgical techniques according to specific stricture locations. However, a careful postoperative follow-up for recurrences is mandatory, since~40% of patients undergoing buccal mucosal graft-augmented urethroplasties were expected to have additional procedures after the index urethroplasty.

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Section: Discussionmentioning

confidence: 99%

Management of complex urethral stricture disease: Algorithm and experience from a single institute

Shau

Kao

et al. 2015

Urological Science

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“…Ventral meatotomy, onlay urethroplasty using transverse island ventral penile skin flap, two stage repair using BMG etc.,[1234567891011] are the commonly used reconstructive options for the management of distal strictures. An ideal urethral substitute should have a dependable blood supply, absence of hair follicles, excellent applicability and immunity from progression of the disease process.…”

Section: Discussionmentioning

confidence: 99%

“…[12] Different graft and flap based repairs have been described with variable success rates. [123456789] However, the ideal management of navicular fossa strictures (NFS) remain unclear. The presence of LSA and the condition of the urethral plate are important factors influencing the choice of the reconstructive technique.…”

Section: Introductionmentioning

confidence: 99%

Single stage ventral onlay buccal mucosal graft urethroplasty for navicular fossa strictures

Chowdhury¹,

Nayak²,

Mallick³

et al. 2014

Indian J Urol

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Introduction:The correction of fossa navicularis strictures poses a distinct reconstructive challenge as it requires attention to cosmesis, in addition to urethral patency. Different graft and flap based repairs have been described with variable success rates. However, the ideal management remains unclear. The feasibility and efficacy of a single stage ventral onlay buccal mucosa graft urethroplasty (VOBMGU) for navicular fossa strictures (NFS) was evaluated in the present study.Subjects and Methods:All patients with NFS attending urology out-patient department from March, 2009 onward accepting VOBMGU were evaluated prospectively. Patients with minimum 1 year of follow-up were included for analysis. The technique involves opening the diseased stenosed meatus ventrally up to the corona. The diseased mucosa is excised leaving a midline strip of native urethral mucosa on the dorsal side. The buccal mucosal graft (BMG) is fixed on either side of this strip over a 24 Fr. silicone catheter. The glans wings are apposed in midline taking anchoring bites on the mucosal graft ventrally. Post-operatively patients were reviewed at 1, 3, 6 and 12 months and annually thereafter. Cosmetic acceptance and splaying of the urinary stream was assessed with individual questionnaires.Results:A total of six patients underwent VOBMGU. Average flow rate at 3 months post-operatively was 12 ml/s. The end result was cosmetically highly acceptable. There was no fistula in any of the cases. With a median follow-up of 37 months, only one patient had a recurrence of stricture in a proximal site.Conclusions:VOBMGU is a viable technique for reconstruction of NFS with promising short term results. However, long-term follow-up is necessary.

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“…Moreover, the existing literature on the subject provides the doctor trying to treat this pathology with a confusing selection of therapeutic options because such publications include patients with pure meatal stenosis, meatal stenosis which extends to the distal urethra, sub-meatal stenosis with a normal meatus and any type of narrowness whichever may be the aethiology [11] . This is why in patients suffering from lichen sclerosus and presenting a distal urethral stenosis that involves the meatus and the navicular fossa, it has been proven that urethroplasty with buccal mucosa graft offers better results than the local skin graft technique (a higher recurrence rate has been noticed when using genital skin) [12] .…”

Section: Discussionmentioning

confidence: 99%

Long-Term Follow-up of Malone Meatoplasty for Meatal Stenosis in Patients with Lichen Sclerosus

Verdejo¹,

Navalon-Monllor²,

Calaforra³

et al. 2017

J Anesth Surg

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Objective: To show our experience in the treatment of meatal stenosis secondary to balanitis xerotica obliterans by the use of a dorsal meatoplasty technique. Materials and methods:We have performed dorsal meatoplasty to 57 patients suffering from meatal stenosis caused by lichen sclerosus. In all cases the individuals were operated on under local anesthesia and following Malone's original technique: plasty through "inverted V" incision. Results: In almost all the operated patients, we observed a significant improvement in urine flow and an excellent aesthetic result with very low incidence of disperse micturition. We have noted a high satisfaction rate by carrying out a survey. We didn't register any post-operative complication. In 2 patients (3.5%) the stenosis reappeared and persisted during an average time of 39.5 months (range 6 -130). Conclusions: Dorsal meatoplasty with "inverted V" incision is an easily executable technique that can be performed under local anesthesia, avoids post-operative hypospadias and gives excellent aesthetic and functional results with low recurrence rate, which is why we hold the opinion that this procedure should be included in the daily practice of the urologist.

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Distal urethroplasty for isolated fossa navicularis and meatal strictures

Cited by 38 publications

References 15 publications

Management of complex urethral stricture disease: Algorithm and experience from a single institute

Management of complex urethral stricture disease: Algorithm and experience from a single institute

Single stage ventral onlay buccal mucosal graft urethroplasty for navicular fossa strictures

Long-Term Follow-up of Malone Meatoplasty for Meatal Stenosis in Patients with Lichen Sclerosus

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