Glans Preserving Buccal Mucosa Urethroplasty for Glandular and Distal Urethral Strictures

BACKGROUND: 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. RESULTS: 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 Q (max) 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. CONCLUSION: 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.