Reconstruction of the Fossa Navicularis

17.1

17.2

17.3

17.4

Reconstruction of Acquired Meatal Stenosis and Strictures of the Fossa Navicularis - 138

Penile Block Technique

Reconstruction of Childhood Meatal Stenosis - 138

Isolated Stricture of the Fossa Navicularis Following Transurethral Resection of the Prostate - 139

Y-V flap Procedures - 139

Resurfacing of Fossa Navicularis - 139

Transverse Ventral Penile Skin Island - 139

Stricture Associated with Early Balanitis Xerotica Obliterans - 142

Stricture of the Fossa Navicularis with Redundancy of Dorsal Penile Skin - 142

Results - 142

References - 143

17.1 Reconstruction of Acquired Meatal Stenosis and Strictures of the Fossa Navicularis

Transurethral resection procedures and early balanitis xerotica obliterans (BXO) have been associated with isolated strictures of the meatus and fossa navicularis. In addition, anatomical anomalies or sequelae of ammoniacal meatitis/balanitis can cause meatal stenosis in children. The choice of procedure for repair of acquired meatal stenosis is dependent on the anatomy of the stenosis and the penile skin. This chapter describes several procedures for reconstruction of the meatus and fossa navicularis using vascularized skin islands.

17.2 Reconstruction of Childhood Meatal Stenosis

Childhood meatal stenosis is usually the result of »fusion« of the meatus following irritation of the tip of the glans in the infant or young child in diapers. Also known as ammoniacal meatitis, this condition is more frequent in the circumcised child. If identified acutely, parent education about the nature of the condition, more frequent diaper changes, and meatal dilations using a child/infant meatal dilator or tip of an ophthalmic antibiotic tube may allow resolution before meatal stenosis develops. The application of a topical steroid to the affected area and on the dilator is also helpful.

When the condition advances, ventral fusion can occur. Ventral fusion can be readily managed with either a ventral meatotomy (□ Fig. 17.1) or a dorsal Y-V flap procedure (□ Fig. 17.2). A Y-V flap procedure is performed by elevation of a V flap from the dorsal glans tissue, creation of an incision through the stenotic area, and advancement of the V flap into the incision to widen the area of the stenosis. The Y-V flap procedure exchanges the redundancy of the dorsal glans tissue for the paucity of tissue at the stenotic meatus or distal fossa. It has been argued that this procedure is preferred over a ventral meatotomy, which could create a retrusive meatus. In our opinion, a ventral meatotomy provides better functional and cosmetic results as the desired slit

Meatal Stenosis Circumcised

O Fig. 17.1A-D. Ventral meatotomy as applied to ammoniacal meatal stenosis. A Local anesthetic is instilled into the obstructing tissue. B The ventral diaphragm of tissue is compressed with a small hemo-

Meatal StenosisFossa NavicularisMeatotomy Repair

O Fig. 17.1A-D. Ventral meatotomy as applied to ammoniacal meatal stenosis. A Local anesthetic is instilled into the obstructing tissue. B The ventral diaphragm of tissue is compressed with a small hemo-

stat. C An incision is created through the tissue. D The creation of the ventral meatotomy. It is important to keep the skin edges separated during healing. (From [9])

□ Fig. 17.2A-C. Y-V advancement for meatal stenosis. A A V-flap is outlined immediately dorsal to the stenosis. B The area of stenosis is incised. C The flap is advanced into the incision. (From [11])

Meatal StenosisMeatal Stenosis

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