Skip to main content

Jordan Fasciocutaneous Ventral Penile / Preputial Island Flap

The Jordan flap is a transverse ventral penile / preputial fasciocutaneous skin island elevated on a dartos fascia pedicle, designed specifically for single-stage reconstruction of fossa navicularis and meatal strictures. It was first described by Gerald H. Jordan in J Urol in 1987 and refined in subsequent technique chapters with Schlossberg.[1][2] Jordan's stated goal was to address the dual challenge of fossa-navicularis reconstruction — restoring urethral patency and maintaining a cosmetically normal-appearing glans — which prior flap procedures had failed to achieve.[1]

This article consolidates the prior separately-listed entries for the Jordan & Schlossberg 1987 transverse-island variant and the Jordan 1999 penile-skin-flap variant, which are the same flap family applied to the same anatomic problem.

For BMG alternatives in the same anatomic location, see Sliding-T Dorsal Inlay (Hoare / Rourke) and Transmeatal OMG Ventral Inlay (Nikolavsky). For the broader penile / preputial pedicled-flap family principles, see Penile / Preputial Flap. For Meatotomy as the simpler first-line option for short meatal stenosis.

Surgical Technique​

The Jordan flap is a transverse skin island on a broad dartos pedicle.[1][3]

StepDetail
1. Skin-island harvestMark a transverse island of skin on the ventral surface of the distal penis / prepuce — hairless, thin, and pliable, ideal for urethral substitution
2. Pedicle dissectionElevate the island on a broad dartos fascia pedicle for reliable, well-vascularized blood supply; dissect the pedicle proximally for adequate mobilization
3. Stricture exposureSplit the glans ventrally or use a glans-cap technique to expose the fossa-navicularis stricture; incise the strictured segment ventrally
4. Flap inlayRotate the skin island into the defect and suture as a ventral onlay to augment the strictured urethra, preserving the dorsal urethral wall. Fine absorbable sutures to the urethrotomy edges
5. GlansplastyReconstruct the glans over the flap to restore a normal slit-like meatus and cosmetic glans contour. Armenakas / McAninch advocate a glans-cap repair for limited dissection and minimal blood loss[3]
6. CatheterUrethral catheter typically removed at 2–3 weeks[4]

Indications​

  • Meatal stenosis and fossa navicularis strictures typically ≤ 2.5 cm in length.[1][5]
  • Recurrent strictures after failed meatotomy or dilation.[5]
  • Post-prostatectomy distal urethral strictures involving the meatus / fossa.[4]
  • Requires intact, healthy penile / preputial skin (uncircumcised or sufficient remaining ventral penile skin).

Contraindications and Limitations​

  • Lichen sclerosus / BXO is the dominant limitation. Jordan's own long-term series (Virasoro / Eltahawy / Jordan 2007) showed 100% excellent results in non-LS patients (23 / 23) at mean 10.2 years but 50% LS / BXO recurrence (6 / 12) in LS patients. The AUA 2023 amendment similarly notes that LS-related strictures are more reliably reconstructed with oral mucosal grafts rather than genital skin flaps.[2][6]
  • Circumcised patients with insufficient remaining ventral penile skin.
  • Strictures > 2.5 cm. Morey 2007 demonstrated that onlay flap repair (including the Jordan technique) is reliable for short isolated fossa-navicularis strictures ≤ 2.5 cm (91% success, 10 / 11) but significantly less effective for longer strictures > 2.5 cm (54% success, 7 / 13, p < 0.05).[7]
  • Diseased or scarred penile skin — extragenital tissue (buccal mucosa) preferred.[3]

Outcomes​

SeriesnFU (mean)SuccessNotable
Jordan 1987 (original)[1]517 mo100%First description; excellent cosmetic / functional outcomes
Fiala 2003[5]2135 mo100%No recurrences; all patients satisfied with cosmesis
Virasoro / Eltahawy / Jordan 2007[2]3510.2 yr83% overall100% non-LS (23 / 23); 50% LS recurrence (6 / 12) — defining LS-vs-non-LS divergence
Onol 2008[4]2630.2 mo96%Post-prostatectomy distal strictures; 1 flap necrosis / fistula

Jordan Flap vs Buccal Mucosa Graft for Fossa Navicularis​

There is no randomized comparative data; the choice is etiology-driven:

  • Non-LS strictures with healthy penile skin — Jordan flap remains an excellent option with near-perfect long-term results (100% at 10+ years).[2]
  • LS-related strictures — buccal mucosa graft is preferred because genital skin is susceptible to LS recurrence. Contemporary single-stage BMG techniques for fossa-navicularis disease — dorsal inlay, ventral inlay, sliding-T — report success of 69–95% depending on series and technique.[8][9][10]
  • Armenakas / McAninch decision rule: if penile skin is healthy, the fasciocutaneous ventral transverse island (Jordan) flap is the preferred urethral substitute; if there is any suggestion of penile-skin inflammation or scarring, extragenital tissue transfer (buccal mucosa) should be used.[3]

Summary​

The Jordan flap is a well-vascularized, reliable, single-stage technique for short fossa-navicularis and meatal strictures in patients with healthy genital skin. Its principal advantage is the combination of excellent functional results with superior cosmesis — a normal-appearing glans and slit-like meatus. Its principal limitation is LS / BXO, where buccal mucosa graft is the preferred substitute, with the Virasoro 2007 100%-vs-50% non-LS-vs-LS divergence at 10-year follow-up the defining selection signal.

Videos​

Transverse Ventral Preputial Island Flap (Jordan Flap)
Ramón Virasoro, MD

References​

1. Jordan GH. Reconstruction of the fossa navicularis. J Urol. 1987;138(1):102-104. doi:10.1016/s0022-5347(17)43006-0.

2. Virasoro R, Eltahawy EA, Jordan GH. Long-term follow-up for reconstruction of strictures of the fossa navicularis with a single technique. BJU Int. 2007;100(5):1143-1145. doi:10.1111/j.1464-410X.2007.07078.x.

3. Armenakas NA, McAninch JW. Management of fossa navicularis strictures. Urol Clin North Am. 2002;29(2):477-484. doi:10.1016/s0094-0143(02)00050-2.

4. Onol SY, Onol FF, Onur S, et al. Reconstruction of strictures of the fossa navicularis and meatus with transverse island fasciocutaneous penile flap. J Urol. 2008;179(4):1437-1440. doi:10.1016/j.juro.2007.11.055.

5. Fiala R, Vrtal R, Zenisek J, Grimes S. Ventral prepucial flap meatoplasty in the treatment of distal urethral male strictures. Eur Urol. 2003;43(6):686-688. doi:10.1016/s0302-2838(03)00186-6.

6. Wessells H, Morey A, Souter L, Rahimi L, Vanni A. Urethral stricture disease guideline amendment (2023). J Urol. 2023;210(1):64-71. doi:10.1097/JU.0000000000003482.

7. Morey AF, Lin HC, DeRosa CA, Griffith BC. Fossa navicularis reconstruction: impact of stricture length on outcomes and assessment of extended meatotomy (first stage Johanson) maneuver. J Urol. 2007;177(1):184-187. doi:10.1016/j.juro.2006.08.062.

8. Zumstein V, Dahlem R, Maurer V, et al. Single-stage buccal mucosal graft urethroplasty for meatal stenoses and fossa navicularis strictures: a monocentric outcome analysis and literature review on alternative treatment options. World J Urol. 2020;38(10):2609-2620. doi:10.1007/s00345-019-03035-8.

9. Hoare D, Fersovich JH, Saavedra A, Rourke KF. Single-stage reconstruction of fossa navicularis strictures using a "sliding-T" dorsal inlay urethroplasty with buccal mucosal graft. Urology. 2021;152:201-202. doi:10.1016/j.urology.2020.12.031.

10. Sterling J, Daneshvar M, Nikolavsky D. Transurethral ventral inlay buccal mucosa graft urethroplasty: technique and intermediate outcomes. BJU Int. 2023;132(1):109-111. doi:10.1111/bju.16007.