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Jordan Fasciocutaneous Ventral Penile / Preputial Island Flap

The Jordan flap is a transverse ventral penile or preputial fasciocutaneous skin island elevated on a dartos fascia pedicle, designed for single-stage reconstruction of fossa navicularis and meatal strictures. Gerald H. Jordan first described it in J Urol in 1987, and the later series in this article use the same flap.[1][2] Jordan described the flap because earlier flap procedures for fossa navicularis strictures did not leave a normal-appearing penis. The goal is to restore urethral patency and keep a cosmetically normal glans.[1]

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 a first-time meatal or fossa-navicularis stricture without prior hypospadias repair, failed endoscopic treatment, prior urethroplasty or LS, AUA 2023 permits initial meatotomy or dilation .[6]

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 thin, pliable distal ventral penile or preputial skin, and confirm that the selected donor skin is non-hair-bearing before urethral substitution.[6] Armenakas describes about 1.5 cm width for onlay or about 2.5 cm for complete substitution over an 18-Fr Foley, sized to the measured circumference; he cautions that tubularization is prone to circumferential restricture and oversizing can cause sacculation.[11] AUA 2023 describes tubularized flaps when no alternative exists, with inferior results compared with onlays; EAU 2026 describes one-stage flap tubes when complete-segment replacement is needed.[6][15]
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 ventrally through the full diseased length to healthy proximal urethra, preserving the dorsal wall.[3]
4. Flap onlayRotate 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] A conical glans without major scarring or distortion favors glans-cap, which preserves the glans and limits dissection; a flattened or severely diseased glans favors glans-wings, which allows excision of fibrotic tissue and anatomic resculpting. An incision directly on the glans is avoided when feasible, for cosmetic reasons[11]
6. CatheterEAU 2026 recommends validated urethrography to assess extravasation before urethral-catheter removal after urethroplasty ; significant extravasation calls for continued drainage and repeat imaging after one week.[14] Onol removed the urethral catheter within three weeks in a 26-patient series.[4] The 2024 atlas describes stent removal at 7–10 days followed by VCUG when the suprapubic catheter is removed at 10–14 days; this obtains imaging after urethral-stent removal and therefore does not provide the EAU pre-removal check.[12][14]

Degloving to the penile base permits tension-free flap rotation. The transverse island is elevated on ventral dartos while preserving a subdermal plexus in the proximal skin to reduce ischemia risk. When glans wings are selected, the lateral glans wings are widely mobilized in the relatively avascular plane between the corporal tips and the glanular erectile tissue. The flap is then transposed and inverted into the defect rather than advanced under tension; a 28–30 Fr neofossa template and a 28-Fr sound guide closure. The pedicle is secured over the urethral suture line to help prevent fistula. Urethral-edge sutures are 5-0 or 6-0 polyglactin; glans closure uses 4-0 polyglactin 910.[12][13]

Indications​

  • Meatal stenosis and fossa navicularis strictures, most reliably when short.[4][7] Morey reported reliable onlay results for isolated strictures ≤ 2.5 cm, and the Onol cohort had strictures < 1.5 cm.[4][7] Jordan and Rourke's 2006 technical chapter states that the flap can be used for strictures up to 4.5 cm.[13]
  • Recurrent strictures after failed meatotomy or dilation. AUA guidelines state that surgeons should offer urethroplasty for recurrent meatal or fossa navicularis strictures .[5][6]
  • Distal urethral strictures after surgery for BPH (the Onol cohort) involving the meatus or fossa.[4]
  • Requires intact, healthy penile or 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. However, 17/35 patients (48%) were lost to follow-up and three died, limiting durability inference. In lichen sclerosus-proven urethral stricture, the AUA states that surgeons should not use genital skin for reconstruction .[2][6]
  • Circumcised patients with insufficient remaining ventral penile skin.
  • Extension into the pendulous urethra. Morey reported onlay success in 10/11 isolated fossa strictures of 1.5–2.5 cm versus 7/13 longer pendulous strictures extending into the fossa (mean 7.4 cm, range 4–16 cm) in a mixed flap-and-graft cohort. The poorer outcomes apply to long pendulous extension; the study provides no isolated-fossa result above 2.5 cm.[7]
  • Diseased or scarred penile skin. Consider extragenital tissue such as buccal mucosa when penile skin is unsuitable.[3] For men with penile urethral strictures, EAU 2026 strongly recommends counseling that adverse intraoperative findings may require conversion to a staged repair.[16]

Complications and Counseling​

Counsel about skin necrosis, fistula, penile torsion or deformity, hypoesthesia, postvoid dribbling, and sacculation; these were reported across penile-skin-flap studies.[15] See Penile / Preputial Flap for reported ranges.

Outcomes​

SeriesnFU (mean)SuccessNotable
Jordan 1987 (original)[1]517 mo (median)All 5 had excellent cosmetic and functional resultsFirst description
Fiala 2003[5]2135 mo100%Meatal and distal strictures; no recurrences; all patients satisfied with cosmesis
Virasoro / Eltahawy / Jordan 2007[2]35 files assessed (45 operated)10.2 yr (reported mean)83% reported success among 35 assessed files (caliber at least 16 Fr without another procedure)23/23 non-LS had excellent results; LS recurred in 6/12; 17/35 were lost to follow-up and three died
Onol 2008[4]2630.2 mo25/26 (96%) functional and cosmetic outcomeDistal strictures <1.5 cm after surgery for BPH; 1 flap necrosis and fistula; no stricture evident in the other 25; mild spraying in all, improved within 6 weeks

Jordan Flap vs Buccal Mucosa Graft for Fossa Navicularis​

There is no randomized comparison specific to Jordan flap versus buccal graft for isolated fossa-navicularis strictures.[15] For urethroplasty generally, EAU 2026 summarizes a small randomized trial excluding LS: penile-skin flaps and oral-mucosa grafts had no statistically significant patency difference, while the flap group had more urogenital morbidity and dissatisfaction.[15] EAU recommends a graft when both options are equally indicated and a flap for a poorly vascularized urethral bed .[15] Distal-site selection also depends on etiology and donor-skin quality:

  • Non-LS strictures with healthy penile skin. The flap is a reasonable option. All 23 non-LS patients in Jordan's retrospective series had excellent results, but 17 of the 35 patients assessed were lost to follow-up.[2]
  • LS-related strictures. Buccal mucosa graft is preferred because genital skin is susceptible to LS recurrence.[8] In Zumstein's mixed-etiology dorsal-inlay cohort (16 prior hypospadias, seven iatrogenic, five inflammatory and four congenital), 22/32 (69%) were free of symptom-driven instrumentation at median 42 months.[8] Sliding-T allowed passage of a 16-Fr cystoscope in 25/27 at mean 29.6 months.[9] Transurethral ventral inlay left 95% of 44 patients patent without further intervention at mean 36 months.[10]
  • Armenakas / McAninch approach. If penile skin is healthy, they prefer the fasciocutaneous ventral transverse island (Jordan) flap as the urethral substitute. If there is a suggestion of penile-skin inflammation or scarring, they advise considering extragenital tissue transfer such as buccal mucosa.[3]

Summary​

The Jordan flap is a well-vascularized, single-stage technique for short fossa-navicularis and meatal strictures in patients with healthy genital skin. Series report functional success with a normal-appearing glans and slit-like meatus. Its main limitation is LS (BXO): in Virasoro’s series, LS/BXO recurred at the fossa or meatus in 6 of 12 patients,[2] and the AUA advises against genital skin in LS-proven stricture.[6] Buccal mucosa graft is the usual substitute. After urethroplasty, monitor for symptomatic stricture recurrence .[6] EAU 2026 recommends routine follow-up for at least one year and patient-reported outcome measures (both strong), with a risk-adjusted protocol ; flap urethroplasty falls in its standard-risk follow-up category.[17]

Videos​

Transverse Ventral Preputial Island Flap (Jordan Flap)
Ramón Virasoro, MD
Jordan Flap: Transverse Ventral Preputial Island Flap
Roger E, et al. Urology Video Journal 2023 (CC BY-NC-ND 4.0)
Open source videoRead the article

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.

11. Armenakas NA. Fossa Navicularis and Meatal Reconstruction. In: Brandes SB, Morey AF, eds. Advanced Male Urethral and Genital Reconstructive Surgery. 2nd ed. Humana Press; 2014:147-160.

12. Monn MF, DeLong JM, Virasoro R, Jordan GH. Reconstruction of Strictures of the Fossa Navicularis Using a Transverse Penile Skin Island Flap (Jordan Flap). In: Joshi PM, Aubé-Peterkin M, Kulkarni SB, Datar G, eds. Surgical Atlas of Urethroplasty. Springer; 2024:317-324.

13. Jordan GH, Rourke KF. Reconstruction of the Fossa Navicularis. In: Schreiter F, Jordan GH, eds. Urethral Reconstructive Surgery. Springer; 2006:137-143. doi:10.1007/3-540-29385-X_17

14. European Association of Urology. "EAU Guidelines on Urethral Strictures: Perioperative Care of Urethral Surgery." Uroweb. 2026. Guideline.

15. European Association of Urology. "EAU Guidelines on Urethral Strictures: Tissue Transfer." Uroweb. 2026. Guideline.

16. EAU Guidelines Office. "EAU Guidelines on Urethral Strictures: Disease Management in Males." Uroweb. 2026. Guideline.

17. EAU Guidelines Office. "EAU Guidelines on Urethral Strictures: Follow Up." Uroweb. 2026. Guideline.