Clinical and diagnostic challenges of fossa navicularis stricture

Fossa navicularis strictures (FNS) pose unique diagnostic and reconstructive challenges due to their rhomboidal anatomy, limited vascularity, and strong association with lichen sclerosus (LS). Patients frequently experience functional disturbance, especially urinary spraying. This is a narrative review that summarizes current evidence on the clinical features, diagnostic evaluation, and management of FNS, with emphasis on anatomical constraints and reconstructive considerations. Conventional imaging often underestimates distal strictures, making clinical history and careful meatal-glans examination central to diagnosis. The native fossa geometry promotes laminar flow but is easily disrupted by reconstruction, contributing to postoperative spraying despite adequate patency. Limited distal blood supply and chronic inflammatory changes further impair healing. Endoscopic treatments show poor durability. Flap repairs may be suitable for non-LS disease, while oral mucosal grafts—buccal or lingual—offer superior outcomes in LS. Optimal management requires accurate clinical assessment and etiology-driven reconstruction. Graft-based urethroplasty remains the most durable option, particularly for LS-associated strictures, highlighting the need for specialized distal urethral expertise.