Transurethral augmentation repair for stricture of fossa navicularis

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Abstract

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

Ibragim E. Mamaev

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

Author for correspondence.
Email: dr.mamaev@mail.ru
ORCID iD: 0000-0002-5755-5950

Ph.D., Head of the Department of Urology of GBUZ “Moscow City Clinical Hospital named after V.M. Buyanov”; Associate professor of the Department of Urology of Pirogov Russian National Research Medical University

Russian Federation, 117997, Moscow, st. Ostrovityanova, 1; 115516, Moscow, Bakinskaya st., 26

Emil M. Alekberov

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

Email: alekberov.e.m@yandex.ru

urologist of the Department of urology of GBUZ “Moscow City Clinical Hospital named after V.M. Buyanov”; Ph.D. student at the Department of Urology of FGAOU VO N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia

Russian Federation, 117997, Moscow, st. Ostrovityanova, 1; 115516, Moscow, Bakinskaya st., 26

Sergey V. Kotov

FGAOU VO N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia

Email: urokotov@yandex.ru
ORCID iD: 0000-0003-3764-6131

Ph.D., MD, professor, Head of the Department of Urology and Andrology 

Russian Federation, 117997, Moscow, st. Ostrovityanova, 1

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2. Fig. 1. Stages of transurethral augmentation plastic surgery of the scaphoid fossa of the urethra A — ventral urethrotomy, formation of a platform for augmentation. B — collection of the labial graft. C — insertion of the needle for subsequent insertion of the ligature, G — optical control of the injection point in the area of the proximal angle of the urethrotomy incision. D — immersion of the graft into the urethra on the formed platform by traction of the ligature. E — the final appearance of the penis after surgery.

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