Unique anatomical and functional considerations of the fossa navicularis of the male urethra

ABSTRACT Distal urethral strictures involving the meatus and fossa navicularis represent a distinct clinical entity with unique anatomical, etiological, and reconstructive challenges. Etiologies include idiopathic, iatrogenic, traumatic, and inflammatory causes, with lichen sclerosus (LS) playing a particularly important role in distal disease. The incidence varies widely depending on the patient population and prior interventions and has increased with contemporary transurethral procedures. Accurate evaluation is often difficult as standard imaging and endoscopic techniques may underestimate the extent of disease in the distal urethra, necessitating a multi-modal diagnostic approach and intraoperative adaptability. The anatomy of the fossa navicularis—characterized by limited corpus spongiosum and soft tissue support—contributes to higher recurrence rates, especially in patients with hypospadias, multiple prior surgeries, or LS. This narrative review summarizes the relevant anatomy, diagnostic considerations, and contemporary surgical strategies. Advances in graft-based reconstruction, particularly with buccal mucosa, and emerging minimally invasive ventral inlay techniques have improved outcomes and expanded the role of single-stage repair in appropriately selected patients.