Urology

June 13, 2023

Strictures of the distal penile urethra and fossa navicularis are historically challenging to treat.  They typically required multistaged surgeries with incisions on or around the penis. Further, these surgeries incorporated different grafts or skin flaps for reconstruction. If patients were not interested in this extent of surgery, they could elect for an extended meatotomy so that their new urethral meatus was located somewhere along the undersurface of the penile shaft.

The outcomes of both interventions were frequently not cosmetically or functionally pleasing to the patient. A novel and more straightforward method for treating these strictures has been developed and is cited in a study published in International Urology and Nephrology.

Katie T. Anderson, M.D., Nick N. Warner, M.D., and Boyd R. Viers, M.D., all urologists at Mayo Clinic in Rochester, Minnesota, have brought this procedure to their practices with the goal of improving outcomes for patients with this condition. The procedure does not require any incisions on the patient's external penile shaft or glans.

During the procedure, the stricture is opened with incisions through the urethral meatus. Once the urethral stricture has been opened and a triangular wedge of scar has been removed, a buccal mucosal graft is parachuted into the defect. Dissolvable sutures are passed through the urethra and out the skin on the ventral aspect of the penis and tied together. These sutures secure the graft in place while it heals and then fall out. Additional sutures are used to secure the end of the graft to the skin. The procedure takes approximately 60 to 90 minutes, and patients can go home the same day. A transurethral catheter stays in place for 1 to 2 weeks.

A benefit of this approach is that patients do not have incisions on the penis or glans, so they do not have the same risk of fistula formation or glans dehiscence compared with older techniques. This procedure has been highly effective and acceptable to patients, regardless of whether the patient's stricture is from prior urethral instrumentation, hypospadias or lichen sclerosus. Given the high success rates for buccal mucosal graft use in other segments of the urethra, this approach is likely to result in long-term success for patients.

For more information

Nikolavsky D, et al. Transurethral ventral buccal mucosa graft inlay urethroplasty for reconstruction of fossa navicularis and distal urethral strictures: Surgical technique and preliminary results. International Urology and Nephrology. 2016;48:1823.

Refer a patient to Mayo Clinic.