Results of transurethral augmentation urethroplasty for stricture of fossa navicularis

Abstract

Background: Stricture of the distal urethra is an actual problem due to the complexity of surgical correction methods capable of providing a high-level aesthetic and functional result. In this regard, we used a new method that meets the above requirements.

Methods: A prospective study of the treatment outcome was conducted in 12 patients with distal urethral stricture at the Moscow City State hospital V.M. Buyanov from 2021 to 2025. The inclusion criterion was the presence of isolated urodynamically significant narrowing of the urethra in the area of the fossa navicularis. All patients underwent transurethral ventral urethrotomy of the narrowed area with optical control of the depth of transection. Subsequently, a triangular fragment of the oral mucosa was taken and fixed in the urethra using the "inlay" technique using 4 sutures (4-0 monocryl) deep in the urethra and 5-7 sutures along the ventral semicircle of the external opening. Restoration of independent urination was achieved on the 12-14th day.

Results: The average age of the patients was 65.5 years. The observation period ranged from 7 to 54 months. The etiologic factor was lichen sclerosus in 8 cases and iatrogenic stricture in 4 patients. The labial mucosa was used as a graft in 9 patients, and the buccal mucosa in 3 patients. No intra and postoperative complications were noted. Average urination quality indicators before surgery: uroflowmetry Q_max 6.12 ± 3.62; IPSS 20.92 ± 6.22. After surgery, Q_max 15.60 ± 4,63; IPSS 7 [4.00; 13.25]. No patient reported urine splashing during urination. All patients were satisfied with the aesthetic result of the surgery. The surgeon's subjective assessment of the convenience of using grafts from the lip and cheek was in favor of the lip mucosa.

Conclusion: The method of transurethral augmentation plastic surgery of the distal urethral stricture using the oral mucosa is an effective and safe method for correcting obstruction of this etiology. The use of the labial mucosa is preferable because of the smaller thickness of the graft. It also preserves the buccal mucosa in patients with lichen sclerosus for possible future reconstruction.

Keywords: Urethral stricture, meatal stenosis, fossa navicularis stricture, augmented urethroplasty.