Historical and Current Practices in the Management of Fossa Navicularis Strictures

Friel, Brian J; Skokan, Alexander; Kovell, Robert Caleb

doi:10.1007/s11934-019-0897-1

Cited by 4 publications

(9 citation statements)

References 35 publications

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“…The processes of healing and re-adhesion of the scars of a torn external urethral orifice further aggravate urethral stenosis. 9 10 A torn urethral orifice is susceptible to contamination, leading to cicatricial stenosis and a worsened condition. The use of external orifice urethrotomy dorsally or ventrally changes the direction of the external urethra, resulting in urinary deviation and splashing post-operatively, poor appearance of the external opening, and a substantial negative effect on the patient’s quality of life.…”

Section: Discussionmentioning

confidence: 99%

Novel strategy using a spiral embedded flap for meatal stenosis after post-penile cancer amputation surgery: a single-center experience

Wang

Liu

Song

et al. 2022

Asian Journal of Andrology

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This study aimed to investigate the curative effect of spiral embedded flap urethroplasty for the treatment of meatal stenosis after penile carcinoma surgery. From January 2015 to January 2021, we used our technique to treat strictures of the external urethral orifice in seven patients, including four cases of meatal stenosis after partial penile resection and three cases of meatal stenosis after perineal stoma. All patients had previously undergone repeat urethral dilatation. The patients underwent spiral embedded flap urethroplasty to enlarge the outer urethral opening. The patients’ mean age at the time of surgery was 60 (range: 42–71) years, the mean operative time was 43 min, and the median follow-up period was 18 months. The patients voided well post-operatively, and urinary peak flow rates ranged from 18.3 ml s −1 to 30.4 ml s −1 . All patients were successful with absence of urethral meatus stricture. The present study showed that using spiral embedded flap urethroplasty to treat meatal stenosis after penile carcinoma surgery is an effective surgical technique with good long-term outcomes.

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Section: Discussionmentioning

confidence: 99%

Novel strategy using a spiral embedded flap for meatal stenosis after post-penile cancer amputation surgery: a single-center experience

Wang

Liu

Song

et al. 2022

Asian Journal of Andrology

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“…32 Adjunct voiding cystourethrogram is similarly commonly used for screening, with particular value in assessing posterior USD. 39 These techniques have the primary advantage of allowing the clinician to identify asymptomatic USD, and to 24,25 Skin flap 12-14% 25,26 Meatal/Fossa Navicularis Meatotomy 2-15% [27][28][29] BMG 7-44% [29][30][31] Skin flap 4-17% 29,31 evaluate the entire length of the urethra simultaneously in order to plan a potential revision operation (Figure 1). Magnetic resonance imaging (MRI) evaluation of USD is rarely employed given the expense of this diagnostic tool and the widely available and less expensive alternatives.…”

Section: Anatomic Failurementioning

confidence: 99%

“…Management is also different, with DVIU quite difficult or impossible due to the anatomic location and the reduced vascularity resulting from a deficiency of spongiosum tissue. 29 For short fossa navicularis or meatal USD, meatotomy is classically performed with good success, though the recurrence rates are significantly higher than with true meatoplasty. 27 Due to this high failure rate, meatotomy is not considered appropriate initial management for recurrent USD except in special circumstances.…”

Section: Management Approachmentioning

confidence: 99%

“…For recurrent meatal or fossa navicularis USD flap urethroplasty (most commonly fasciocutaneous ventral transverse island skin flap) has a longstanding record of success and is an excellent option if adequate source tissue is available. 29 , 31 If local flaps have been exhausted or are contraindicated due to LS, buccal mucosal graft (BMG) can be used in these distal areas though more complex techniques are required, including double grafting with or without the creation of glans wings to enhance vascular support to the new grafts. 28 , 55 , 56 …”

Section: Management Approachmentioning

confidence: 99%

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Recurrent Anterior Urethral Stricture: Challenges and Solutions

Mershon¹,

Baradaran²

2021

RRU

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Recurrent male anterior urethral stricture disease is a complex surgical challenge that should be managed by reconstructive urologists with experience in stricture management. Diagnosis of recurrence requires both anatomic narrowing and patient symptoms identified on validated questionnaires, with limited role for intervention in asymptomatic treatment "failures". Endoscopic management has a very specific role in recurrence, and the choice of technique for urethroplasty depends on pre-operative urethrography and cystoscopy. Surgical success depends on addressing patient concerns, complete stricture excision, tissue quality optimization, and the use of multi-stage repair when indicated. Augmentation with genital skin flaps and/or grafts is often required, with buccal mucosa as the ideal graft source if local tissue is compromised. Salvage options including urinary diversion and perineal urethrostomy must also be considered in debilitated patients with severe disease or repeated treatment failures. Unique patient populations including patients with hypospadias and lichen sclerosis are among the highest risk for repeated recurrence and require special care in surgical technique, graft selection, and post-operative management.

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“…Distal penile and fossa navicularis strictures (FNS) have traditionally posed a particular challenge for reconstructive urologists. Treatment approaches have used ventral or circumferential penile skin incisions to access the urethra and then utilise fasciocutaneous flaps or buccal mucosa grafts (BMGs) to rebuild the strictured area [1,2]. These approaches have several notable downsides, including external skin incisions in places that are prone to breakdown and less desirable cosmetic outcomes, high likelihood of multi-stage repairs, and variable results in patients with lichen sclerosis or history of hypospadias [3,4].…”

Section: Introductionmentioning

confidence: 99%

Transurethral ventral inlay buccal mucosa graft urethroplasty: technique and intermediate outcomes

2023

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Link to accompanying video: https://www.dropbox.com/s/lc4q8dmd1ukjzsb/BJU-2022-1023.R1%20Revised%20Video.mp4?dl=0. ObjectiveTo outline our step-by-step surgical technique for a transurethral ventral buccal mucosa graft inlay urethroplasty to treat fossa navicularis and distal urethral strictures. MethodsThe transurethral ventral inlay urethroplasty is accomplished in four steps. First, after obtaining proper exposure the cicatrice is excised via a transurethral ventral urethrotomy until the lumen is at least 24fr. Second, double arm 6-0 polydioxanone suture is used to deliver the triangular buccal mucosal graft to the proximal extent of the urethrotomy and secured externally. Third, the graft is secured to the meatus with 5-0 polyglactin sutures and additional 6-0 double arm polydioxanone sutures are used to quilt the graft for spread fixation. Finally, a 16fr silicone catheter is placed. Patients are discharged the same day and return for void trial after one week. A retrospective, single institution review was conducted to include all patients who underwent this procedure with a minimum of 1 year follow-up. Patients were analyzed for recurrences, and pre-and post-operative urine flow rates, post void residuals, and patient questionnaires were also reviewed. Results44 patients met our inclusion criteria. Median surgical time was 120 minutes. At a mean follow up of 36 months (IQR 22-50) 95% of patients are patent without additional interventions. The 2 patients that did have stricture recurrence were found to have urethral stenosis that extended more proximally, and both were successfully treated with a dorsal onlay buccal urethroplasty. There were significant improvements in urine flow rate, post void residuals, international prostate symptom score and quality of life scores post operatively. There was no difference in post operative sexual function scores. ConclusionThis minimally invasive transurethral ventral urethroplasty has excellent intermediate term outcomes in terms of traditional objective measures of urethroplasty success and patient reported outcomes.

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Historical and Current Practices in the Management of Fossa Navicularis Strictures

Cited by 4 publications

References 35 publications

Novel strategy using a spiral embedded flap for meatal stenosis after post-penile cancer amputation surgery: a single-center experience

Novel strategy using a spiral embedded flap for meatal stenosis after post-penile cancer amputation surgery: a single-center experience

Recurrent Anterior Urethral Stricture: Challenges and Solutions

Transurethral ventral inlay buccal mucosa graft urethroplasty: technique and intermediate outcomes

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