Transurethral augmentation repair for stricture of fossa navicularis

Mamaev I.E., Alekberov E.M., Kotov S.V.

1) FGAOU VO N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia; 2) GBUZ “Moscow City Clinical Hospital named after V.M. Buyanov”, Moscow, Russia

A stricture of fossa navicularis is a significant challenge due to the complexity of surgical reconstruction which should provide good aesthetic and functional outcomes.
Aim. To evaluate the efficiency and safety of transurethral ventral augmentation urethroplasty in men with stricture of fossa navicularis.
Materials and methods. A prospective study of treatment outcomes of 9 patients with stricture of fossa navicularis who were admitted at V.M. Buyanov City Clinical Hospital from 2021 to 2024, was carried out. The inclusion criterion was the presence of an isolated urethral narrowing in the fossa navicularis, which was urodynamically significant. All patients underwent transurethral ventral urethrotomy of the narrowed segment using a lance scalpel with optical control of the depth of incision. Subsequently, a triangular oral mucosa graft was harvested and fixed using the “inlay” technique with 4 deep sutures (monocryl 4-0) in and 5 sutures along the ventral semicircle of the meatus. The urethral catheter was removed on days 12-14 in order to restore spontaneous voiding.
Results. The mean age of patients was 63.4 years. The follow-up period ranged from 6 to 38 months. The etiology was balanitis xerotica obliterans (BXO) in 5 cases, unknown in 2, and iatrogenic stricture in 2 patients. Labial mucosa was used as a graft in 6 men, and buccal mucosa in 3 cases. No intra- or postoperative complications were observed. Preoperatively, average maximum urine flow rate was 5.8 ml/sec, IPSS score 20.5 points. After surgical treatment, the average Qmax was 15 ml/sec, and the IPSS score was 13. No patient reported urine splashing.
Discussion. All patients experienced the satisfaction with both functional and aesthetic outcomes. The surgeon's subjective assessment of the convenience and the cosmetic result of using labial and buccal grafts favored labial mucosa. It seems to be preferable both due to the lesser thickness of the graft, which facilitates the technical manipulations, and in terms of preserving the buccal mucosa in patients with BXO for possible subsequent reconstructions.
Conclusions. The transurethral augmentation repair using oral mucosa is an effective and safe method for treatment of stricture of fossa navicularis.

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About the Authors

Corresponding author: I.E. Mamaev – Ph.D., Head of the Department of Urology of GBUZ “Moscow City Clinical Hospital named after V.M. Buyanov”, Moscow, Russia, associate professor of the Department of Urology of FGAOU VO N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, e-mail: dr.mamaev@mail.ru

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