Treatment of male anterior urethra strictures: Meatus, navicular fossa and penile urethra

Abstract

IntroductionDistal anterior urethral strictures (DAUS) affect the meatus, navicular fossa (NF) and penile urethra (PU). The main causes are inflammatory (lichen sclerosous [LS]), traumatic iatrogenic, or idiopathic. Post-hypospadias stenosis is common and constitutes a separate entity, dealt with in a separate article. MethodA summary of North American, European and French recommendations was drawn up, supplemented by a literature search from December 2020 to December 2023, to provide a current overview of strategies adapted to DAUS. ResultsStricture limited to the meatus without LS can be dilated once. From the 1st recurrence or in the presence of LS, only a ventral or dorsal meatoplasty will be effective. In cases of Navicular involvement, an augmentation urethroplasty, respecting the glans penis (aesthetic preservation) will be preferred. Severe cases or recurrences may require replacement urethroplasty in two or more stages. PU stricture should not be treated by endoscopic urethrotomy but by urethroplasty in all cases. A one-stage augmentation technique will be discussed with a staged (2 stages most often) urethroplasty depending on the severity of the obstruction, stricture length, recurrent nature and the presence of LS. Buccal mucosa (jugal, lingual) is the most commonly used material in the form of a free graft. The most complex cases may require a perineal urethrostomy. ConclusionDAUS present in a variety of ways. They are mainly managed surgically, in one or more stages. It is necessary to master several techniques to adapt to their heterogeneity.