Glans preservation techniques for fossa navicularis strictures prioritizing aesthetics and quality of life beyond patency

Fossa navicularis strictures (FNS) present a distinct reconstructive challenge due to the functional and aesthetic importance of the distal urethra. While classical treatments such as meatotomy, endoscopic incision, and open urethroplasty can restore patency, they are frequently associated with high recurrence rates, glans distortion, and compromised quality of life (QoL). Increasing emphasis on patient-reported outcomes has driven the development of glans-preserving reconstructive techniques. To provide a structured overview of contemporary glans-preserving surgical techniques for FNS, with specific focus on QOL beyond urethral patency. A narrative review of the literature was performed, focusing on modern ventral transmeatal and dorsal glans-sparing urethroplasty techniques using buccal mucosa grafts. Outcomes of interest included patency, urinary flow, lower urinary tract symptoms, sexual function, cosmetic results, and patient-reported satisfaction. Across contemporary series, glans-preserving urethroplasty techniques demonstrate high patency rates (approximately 85–95%), significant improvement in urinary symptoms, and low rates of major complications such as fistula or glans dehiscence. Both ventral and dorsal approaches effectively restore urethral caliber while preserving glans anatomy, slit-like meatal configuration, and cosmetic appearance. Reported sexual function outcomes are favourable, with minimal de novo erectile dysfunction. However, direct comparative data between techniques and long-term patient-reported outcomes remain limited. Glans-preserving urethroplasty represents a meaningful evolution in the management of fossa navicularis strictures, achieving durable functional outcomes while prioritizing aesthetics and quality of life beyond patency alone. These techniques form a complementary spectrum that should be tailored to stricture characteristics and patient history. Future prospective, multicenter studies incorporating standardized patient-reported outcome measures are needed to refine technique selection and optimize patient-centered care.