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Ventral Onlay Glanuloplasty

Ventral onlay glanuloplasty (VOG) is a single-stage buccal mucosal graft reconstruction for selected fossa-navicularis strictures. Wayne and colleagues described a ventral glans incision with graft onlay and closure without extensive glans-wing mobilization. Their reported outcome cohort excluded lichen sclerosus; its findings should not be presented as evidence for LS-specific repair or split-thickness skin grafting.[1]

Selection​

Define distal stricture extent and tissue quality before choosing VOG, transmeatal grafting, meatoplasty or staged reconstruction. The published series addressed fossa-navicularis disease and permitted separately treated proximal skip strictures. Its median stricture length was 2 cm, with some longer strictures included. For LS, current EAU guidance favors oral mucosa over genital skin and individualizes single-stage versus staged repair to local tissue conditions.[1][2]

Technique Overview​

The following summarizes the published technique rather than prescribing dimensions for every patient.[1]

  1. Open the ventral glans in the midline from the meatus to healthy proximal urethra; use stay sutures and endoscopic assessment to define the defect.
  2. Harvest, defat and tailor buccal mucosa. Suture its proximal apex and lateral edges to the ventral urethrotomy margins to augment the distal lumen.
  3. Cover the graft with dartos tissue and reapproximate the glans without extensive glans-wing undermining. Mature the distal graft edge to the glans to form the neomeatus.
  4. Check caliber and tension, then catheterize. The authors used a three-week catheter period with voiding cystourethrography before removal; postoperative management remains reconstruction-specific.

Outcomes and Limits​

Of 11 treated patients, one with LS was excluded from the reported analysis. Nine of ten analyzed patients met the study success definition at median 30-month follow-up; one recurrence required dilation and triamcinolone. All ten reported satisfaction with appearance, and no 30-day complications were recorded. This small uncontrolled retrospective series does not establish superiority, exclude uncommon harms, or provide LS-specific durability.[1]

See Also​

References​

1. Wayne G, Perez A, Demus T, et al. Ventral onlay glanuloplasty for treatment of fossa navicularis strictures. Int Braz J Urol. 2022;48(5):798–804. doi:10.1590/S1677-5538.IBJU.2022.0067. Full text.

2. EAU Guidelines on Urethral Strictures: disease management in males. Guideline. Accessed September 12, 2026.