BERKELEY, CA (UroToday.com) - The treatment of distal urethral strictures has evolved in the last 2 decades from management via dilation and internal urethrotomy to definitive reconstruction via techniques such as penile fasciocutaneous flap urethroplasty and buccal mucosa graft urethroplasty. Few studies have compared outcomes and examined indicators for successful repair.

A recent report from Allen Morey from San Antonio examined his series of patients treated for fossa navicularis (FN) strictures and evaluates factors contributing for successful repair. The report is published in the January 2007 issue of the Journal of Urology.

Over a 6 year period, 40 males with an average age of 31 years underwent open repair of resistant strictures of the fossa navicularis. Previous therapy included dilations in 13 cases (33%), direct visual urethrotomy in 12 cases (30%), 5 hypospadias repairs (13%), and 11 anterior urethroplasties (28%). Stricture lengths, type of repair, severity, length of follow-up and patient demographics were recorded. Men having a 1-stage onlay urethroplasty were subdivided into those that had strictures measuring 2.5 cm or less, and group 2 had strictures greater than 2.5 cm extending into the FN. Group 3 consisted of patients were treated with an extended meatotomy technique similar to a first-stage Johanson procedure. Successful outcomes were defined as one that did not require further instrumentation and allowed for adequate voiding.

Average follow-up was 52 months. Groups 1 and 2 consisted of 24 men who received a one-stage onlay urethroplasty with a ventral fasciocutaneous flap in 22 patients and a ventral onlay buccal mucosa urethroplasty in 2 patients who had inadequate penile skin. The success rate in group 1 was 91% (10 of 11) and the mean stricture length was 2.2 cm. The success rate in group 2, in which the mean stricture length was 7.4 cm, was only 54% (7 of 13). In group 3, the extended meatotomy proved to be highly successful with a success rate of 88% (14 of 16 patients). These mean had complex strictures with a mean length of 4.2 cm. No patient in this group elected to have a second-stage repair.

Stricture length appears to be an important variable in assessing outcomes of distal urethroplasty. Fasciocutaneous flap urethroplasty is an excellent option for those men with short strictures but is less reliable for longer strictures involving the fossa navicularis in this group. For men with advanced strictures of the distal penile urethra, the extended meatotomy maneuver (first stage Johanson) appears to provide a durable repair that may be preferable to a perineal urethrostomy or multistage repairs.

Morey AF, Lin HC, DeRosa CA, Griffith BC

J Urol. 2007 Jan; 177(1):184-87

UroToday.com Urologic Trauma & Reconstruction Section

Written by Michael J. Metro, MD, a Contributing Editor with UroToday.

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