ABSTRACT Urethral strictures located at the level of the meatus and the fossa navicularis (FN) are typically short in length and are commonly associated with lichen sclerosus. Other etiologies include iatrogenic, infectious, and idiopathic causes, with iatrogenic causes typically resulting from prior instrumentation or catheterization. Hypospadias-associated strictures represent a distinct clinical entity with a different underlying cause and are not addressed in this article. For many years, reconstructive surgeons have consistently reported concern about the significant challenges associated with managing strictures in this anatomically and functionally delicate region. Surgical reconstruction requires not only the restoration of adequate urinary flow but also careful consideration of cosmetic outcomes. Concerns regarding recurrence, unsatisfactory aesthetic results, and complications, such as fistula or diverticulum formation, continue to influence therapeutic decision-making. Moreover, an exceptionally wide range of surgical techniques has been described in the literature. Recommendations in current guidelines are often imprecise and do not clearly define a preferred management strategy for distal urethral strictures. This narrative review aims to present the various surgical techniques available for the treatment of meatal and FN strictures in adult males. It outlines the indications, surgical principles, and reported outcomes of the different procedures, intending to support reconstructive surgeons in their clinical decision-making process.
Ohnesorge et al. (Thu,) studied this question.