[Nikolavsky-type transurethral ventral inlay buccal mucosa graft urethroplasty]

The treatment of meatal and fossa navicularis strictures remains challenging. Internal urethrotomy is ineffective in this segment, whereas open urethral reconstruction may result in cosmetically unfavorable scars and carries a risk of fistula formation. To overcome these limitations, Nikolavsky and colleagues developed a transurethral urethroplasty technique using oral mucosa. It allows curative treatment with low morbidity and favorable cosmetic outcomes. Our aim was to perform this procedure for the first time in Hungary. In this case report, we present the outcome of our first case. A 57-year-old man presented with recurrent meatal stenosis secondary to lichen sclerosus after local steroid therapy and multiple urethral dilations. Retrograde urethrography confirmed a 2-cm-long stricture extending from the meatus into the fossa navicularis. Nikolavsky-type transurethral ventral inlay buccal mucosa graft urethroplasty was performed. The scar tissue of the strictured urethral segment was excised transurethrally, and a buccal mucosa graft was placed into the defect. The graft was inserted through the urethral meatus and secured to the ventral urethral defect with absorbable sutures. The operative time was 105 minutes, and the hospital stay was 2 days. The urinary catheter was removed 21 days after surgery. No intraoperative or postoperative complications occurred. At 2, 6, and 12 months after surgery, uroflowmetry showed maximum urinary flow rates of 22, 39, and 29 ml/s, respectively, with no postvoid residual urine at any follow-up visit. The International Prostate Symptom Scores were 5, 2 and 3, and the quality-of-life scores were 1, 0, and 0, respectively. Based on the favorable outcome of our first case, this approach may become a valuable addition to our urethral reconstruction armamentarium. Orv Hetil. 2026; 167(37): 1483-1487.