Transmeatal dorsal-inlay buccal mucosal graft augmentation for reconstruction of meatal stenosis and fossa navicularis strictures: Technical considerations and short-term functional outcomes

Background: Reconstruction of fossa navicularis strictures (FNS) is challenging due to the difficulty in restoring urethral patency while preserving optimal cosmetic outcomes. This study evaluated the feasibility, technical considerations, and short-term functional outcomes of transmeatal dorsal-inlay buccal mucosal graft (BMG) augmentation for FNS reconstruction. Materials and Methods: A retrospective review was conducted of all patients who underwent transmeatal dorsal-inlay BMG augmentation for FNS between January 2019 and December 2023. Data collected included demographics, symptom scores, stricture characteristics, radiological imaging, and maximum urinary flow rates (UFR-Qmax). The surgical technique involved a transmeatal approach, utilizing a dorsal midline meatotomy incision extending to the proximal normal urethral mucosa at the fossa navicularis, followed by dorsal-inlay BMG augmentation. Follow-up assessments included Patient-Reported Outcome Measure for Urethral Stricture Surgery (PROM-USS) scores, cosmetic evaluation, and UFR-Qmax. Failure was defined as bothersome voiding symptoms, UFR-Qmax <10 mL/s, or inability to calibrate the urethra with a 14-Fr catheter. Results: Twenty-eight patients (mean age: 38 ± 9 years) were included in the study. Recurrence occurred in three patients (10.7%), all with Lichen sclerosus (LS). One additional patient developed a symptomatic suture granuloma. LS strictures demonstrated higher recurrence (30% vs. 5.6%), though not statistically significant ( P = 0.12). Significant improvements ( P < 0.05) were observed in dysuria, UFR-Qmax, and PROM-USS compared with the preoperative periods. Functional and cosmetic satisfaction were reported by 86% of patients. Conclusion: Transmeatal dorsal-inlay BMG augmentation is a feasible alternative to FNS reconstruction. Despite potential technical challenges, this approach offers satisfactory functional and cosmetic outcomes. Caution is warranted in LS-related strictures due to higher recurrence tendencies.