ABSTRACT The management of fossa navicularis strictures (FNS) has evolved through more than a century of surgical innovation. Initial treatment methods included mechanical dilation, urethrotomy, and meatotomy; however, these techniques frequently exacerbated scarring and did not resolve the underlying pathological condition. The absence of anatomical insight and limited understanding of disease etiology led to crude, palliative interventions. The recognition of lichen sclerosus (LS) in the mid-twentieth century marked the first major conceptual shift, establishing LS as the predominant cause of distal strictures and revealing the limitations of skin-based repairs. The late twentieth century saw the first reconstructive revolution with Jordan’s ventral transverse island flap, which provided anatomically faithful and cosmetically superior reconstruction, validated by long-term outcomes. A second paradigm shift occurred in the early 2000s with the emergence of oral mucosal grafts, driven by the seminal works of Armenakas and McAninch. Modern refinements—including glans-preserving concepts, minimally invasive graft placement, and novel circumferential grafting—reflect the ongoing maturation of reconstructive principles. This is a historical narrative review that provides a synthesis tracing the evolution of FNS management from early empirical techniques to contemporary pathology-guided reconstruction.
Sharin et al. (Thu,) studied this question.