Glans tunnel-based reconstruction with skin flap or lip mucosa graft for distal penile urethral strictures.

Purpose: The aim of this study is to evaluate the clinical efficacy of glans tunnel urethroplasty using a pedicled penile flap or lower lip mucosa for glans penis urethral stricture. Methods: A retrospective analysis was conducted on 41 patients with urethral stricture at the glans penis who visited our hospital from January 2021 to July 2025. Causes include iatrogenic factors (including prostate hyperplasia surgery, transurethral resection of bladder lesions and catheterisation), a history of hypospadias repair and penile lichen sclerosus (LS), including 14 cases of urethral meatus stricture and 27 cases of navicular fossa stricture. The length of the stricture was 2.0 (1.0, 3.0) cm, the maximum flow rate (Q max) was (7.24 ± 3.47) ml/s, the International Prostate Symptom Score (IPSS) was (17.49 ± 5.29), and the International Index of Erectile Function - 5 (IIEF-5) was 14.0 (9.00, 21.00) points. Surgery preserved glans integrity, incised the ventral stenotic urethra and reconstructed the defect with a flap or mucosa graft. A F16/18 indwelling catheter was removed after 3 weeks. Pre- and post-operative uroflowmetry, IPSS and IIEF-5 evaluations were conducted. Results: All post-operative outcomes were assessed at 12-23 months (median 20, IQR 19-21). Postoperative Q max increased to 23.61 ± 4.54 ml/s, and the IPSS decreased to 9.02 ± 3.57 (both P < 0.001 vs. pre-op). The IIEF-5 score (14.71 ± 6.48) points showed no significant change. No recurrence, glans dehiscence, fistula, infection or ischaemia occurred. Conclusions: Glans tunnel urethroplasty maintaining glans integrity effectively treats urethral meatal and navicular fossa strictures, balancing function and aesthetics.