Glans Preserving Buccal Mucosa Urethroplasty for Glandular and Distal Urethral Strictures

To describe a step-by-step approach for glans preserving urethroplasty with a dorsal inlay graft used for distal urethral strictures. Description of the Technique: The reconstruction was performed through a keyhole incision in the urethra. In this way, we achieve maximal exposure by a minimal incision and saving of the glans. After incision of the diseased dorsal urethral mucosa through the keyhole and the meatus, a buccal mucosa graft pull-through resulting in a dorsal inlay is done. Patient(s) and Methods: We treated 10 patients in different clinical settings with success by using the newly described technique below. We highlight and illustrate 1 case of a 34-year-circumcised male. Antegrade urethrogram showed a distal penile and fossa navicularis stricture with a total estimated length of 3.5 cm.

In this specific case the glans sparing approach had a surgical duration of 115 minutes. After 3 weeks the urinary catheter was removed. At 12 months, the patient reported no remaining urinary tract symptoms. Examination showed a fully healed lesion and an adequate uroflowmetry with a Qmax of 24 mL/s coming from 4 mL/s pre-operatively. In our 10-patient case series, all treated patients had complete resolution of their complaints, significant improvement in flow rates and excellent cosmetic results without complications.

In selected cases, the described technique is feasible, safe, and effective with excellent functional outcomes and better cosmetic results especially due to the glans preservation.