Management of fossa navicularis strictures

Abstract

The correction of strictures involving the fossa navicularis poses a distinct reconstructive challenge. Unlike surgical repair of strictures involving other urethral segments where the primary concern is restoration of urethral patency, management of fossa navicularis strictures also requires particular attention to cosmesis. Paramount to the success of any of the described procedures is the careful selection of nondiseased tissue for substitution. If the penile skin is healthy, the preferred urethral substitute is the fasciocutaneous ventral transverse island flap. The inherent characteristics of this versatile flap (i.e., well-vascularized predictable pedicle, nonhair bearing, negligible contraction) provide for an excellent time-tested glandular urethral substitute. In rare cases in which there is a suggestion of penile skin inflammation or scarring, extragenital tissue transfer techniques should be considered. Equally important is the need to substitute the entire length of diseased urethra, preferably as an onlay, preserving the dorsal urethral wall. Persistent proximal urethral disease will eventually result in further stricture formation. Finally, the choice of glanduloplasty is particularly important in achieving a cosmetically appealing outcome. A glans-cap repair is preferred because of the limited dissection required with this relatively simple and bloodless technique. Careful selection of the most appropriate combined urethral substitution and glans reconstruction techniques, as well as meticulous attention to surgical details, are mandatory for achieving a satisfactory functional and cosmetic outcome with fossa navicularis strictures.