Ventral Onlay Glanuloplasty
Ventral onlay glanuloplasty applies a buccal mucosal or split-thickness skin graft to the ventral aspect of the glans penis and fossa navicularis after excising scarred meatal and perimeatal tissue.[1] The graft augments the distal urethra and reconstructs the meatal opening in a single stage. This technique is well-suited for lichen sclerosus–related meatal stenosis and fossa navicularis strictures where the native tissue is unsuitable.[2]
Indications
| Indication | Practical fit |
|---|---|
| Lichen sclerosus meatal stenosis / fossa navicularis stricture | Replaces diseased ventral distal urethral / glanular tissue with graft |
| Distal stricture with scarred meatal plate but salvageable glans | Single-stage augmentation rather than staged distal reconstruction |
| Failed meatotomy / meatoplasty with recurrent narrowing | Adds epithelial surface instead of simply cutting scar again |
| Patient needs a slit-like functional meatus rather than a hypospadiac opening | Glanuloplasty reconstructs the distal opening while augmenting caliber |
Technique Overview
The operation excises or releases scar at the meatus / fossa navicularis and places a buccal mucosa or split-thickness skin graft as a ventral onlay. The graft must sit on a vascularized bed, be quilted or fixed securely, and be protected from shearing while it inosculates.
Key Steps
- Mark the stenotic meatus and involved fossa navicularis.
- Open the ventral glans / distal urethra through healthy tissue.
- Excise dense lichen-sclerosus or scarred epithelium until a vascular bed remains.
- Harvest and defat buccal mucosa or prepare STSG, depending on local tissue and surgeon preference.
- Quilt or secure the graft to the ventral glanular bed.
- Reconstruct the meatal margins without tension or graft folding.
- Stent with a small catheter and protect the graft from compression / hematoma.
Outcomes & Evidence
Evidence is limited compared with bulbar BMG urethroplasty, but the rationale is strong in distal strictures where repeat dilation or meatotomy fails. Outcomes depend heavily on lichen-sclerosus control, graft-bed quality, and avoidance of distal ischemia. Persistent or recurrent LS should be treated medically and followed long-term.
See Also
References
1. Morey AF, Lin HC, DeRosa CA, Griffith BC. "Fossa navicularis reconstruction: inlay skin graft technique for strictures distal to fossa." J Urol. 2007;177(1):311–5. PMID: 17162074
2. Levine LA, Strom KH, Lux MM. "Buccal mucosa graft urethroplasty for anterior urethral stricture repair: evaluation of the impact of stricture location and lichen sclerosus on surgical outcome." J Urol. 2007;178(5):2011–5. PMID: 17869297