Distal urethroplasty for isolated fossa navicularis and meatal strictures.

BJU Int 2012, 109: 616-619
Strictures of the distal urethra/fossa navicularis are often difficult to manage and objective and patient reported outcomes have not been described.
Meatotomy is highly successful in terms of both stricture recurrence and patient satisfaction. Meatoplasty, while often reserved for more complicated and long strictures, has a high rate of success. Men with lichen sclerosus have a higher rate of stricture recurrence with meatal repairs.
OBJECTIVE: Urethral strictures located in the fossa navicularis are common and are often managed with meatotomy or meatoplasty.Few data have described the outcomes for men after urethroplasty or patient satisfaction following these procedures.
METHODS: In all, 93 men at two different institutions underwent surgical repair of distal urethral stricture disease using meatotomy (73) or meatoplasty (20), with 13/20 (65%) of the latter group undergoing substitution urethroplasty. In patients with lichen sclerosus (LS), all involved tissue was excised prior to reconstruction. In a subset of men undergoing meatotomy, patient satisfaction was evaluated by questionnaire.
RESULTS: Average clinical follow-up for men undergoing distal urethroplasty was 61 months. Successful reconstruction requiring no further intervention occurred in 84% of men overall. Subgroup analysis revealed success in 87% of men with meatotomy, 75% with meatoplasty and 66% with substitution urethroplasty. Men with LS had a significantly greater rate of stricture recurrence (20.5% vs 7.5%, P= 0.04). Of the subset of men who completed a patient-based questionnaire 84% reported they were either satisfied or very satisfied with the results of their meatotomy.
CONCLUSION: We report the success of distal urethral stricture management. Meatal strictures may be approached successfully in a stepwise manner progressing from meatotomy to meatoplasty for longer recurrent strictures, with a high overall success rate for meatotomy. Although substitution grafts may be useful for men with longer distal strictures and those with LS, the risk of recurrence was significantly higher in this cohort.