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Meatotomy & Meatoplasty

Meatotomy is the surgical incision of the urethral meatus, while meatoplasty is the formal reconstruction of the urethral meatus, including local-flap, free-graft, and BMG-based variants. Both target meatal stenosis (narrowing of the external urethral opening). This page addresses penile meatal stenosis in children and adults; see Female Urethral Stricture for the distinct female approach.[34] A retrospective pediatric comparison (Dothan 2023, n = 2,211) reported no reoperations after meatoplasty versus 0.58% after meatotomy in differently selected groups.[1][2]

For longer fossa-navicularis disease that extends beyond the meatus, see Sliding-T Dorsal Inlay (Hoare / Rourke) and Transmeatal OMG Ventral Inlay (Nikolavsky). For the Jordan flap meatoplasty (ventral preputial island), see Jordan Fasciocutaneous Ventral Penile / Preputial Island Flap. For lichen-sclerosus-driven distal disease, see Lichen Sclerosus. For the broader urethral-stricture treatment framework, see the Master Decision Framework.

Epidemiology and Pathophysiology​

  • Post-circumcision. Circumcision is the setting in which meatal stenosis is most often reported in boys. A meta-analysis of 27 studies across ages estimated meatal-stenosis risk in circumcised males at 0.66% (95% CI 0.44–0.91); comparative evidence that circumcision raises the risk is weak (three observational studies, OR 3.20, 95% CI 0.73–13.9).[3] In a meta-analysis of circumcisions performed by health-care professionals across age groups, complications requiring treatment occurred in 3.84% overall and 7.47% of therapeutic circumcisions; adhesions, meatal stenosis and infections were the most frequent complication subgroups after therapeutic circumcision.[4] The traditional chemical or mechanical-trauma-from-diaper hypothesis has been challenged.[3][4][5]
  • Post-hypospadias repair. Meatal stenosis is a recognized complication, often from circumferential scar contracture at the neomeatus.[6][7]
  • Lichen sclerosus (BXO). A major cause in adults and older boys. Up to 1 in 5 boys circumcised for LS later require a meatal procedure; among 93 men who underwent distal stricture repair, recurrence was 20.5% with LS versus 7.5% without LS (p = 0.04).[8][9]
  • Iatrogenic. Prior urethral instrumentation, catheterization, transurethral surgery.
  • Atopic or inflammatory. Boys with meatal stenosis have a 61% history of allergic disease versus 13% of controls.[10]

In Dothan’s surgically treated pediatric cohort, deviated urinary stream was the most frequent indication (1,477/2,211; 67%). Children may also present with dysuria, difficult-to-aim stream, frequency, and occasionally retention; physical examination reveals a pinpoint meatus with an upward thin forceful stream.[1][2]

Indications​

For a known adult urethral stricture, the AUA 2023 guideline advises determining its location and length before nonurgent intervention .[11]

For treatment, the AUA 2023 urethral stricture guideline amendment states:[11]

  • First-time, uncomplicated meatal or fossa-navicularis stricture: surgeons may treat with dilation or meatotomy , unless it is associated with prior hypospadias repair, failed endoscopic treatment, prior urethroplasty, or LS.[11]
  • Recurrent meatal or fossa-navicularis strictures: surgeons should offer urethroplasty .[11] The guideline text lists meatoplasty, extended meatotomy and several urethroplasty variations as reconstructive options.
  • LS-associated strictures: the guideline text states that oral mucosal grafts are more likely to achieve successful reconstruction.

Meatotomy vs Meatoplasty — Dothan 2023 Comparison​

The retrospective Dothan cohort provides pediatric reoperation data, with different presentations associated with the procedure chosen.[2]

ParameterMeatotomy (n = 1 906)Meatoplasty (n = 305)
Reoperation rate0.58% (11 patients)0%
Manual meatal spreading at first postoperative visit3.6% (69 patients)Not reported
Operative durationNo differenceNo difference
Recovery timeNo differenceNo difference
Presentation associated with selectionDeviated stream (OR 1.47)Urinary retention (OR 4.5)

Standard Ventral Meatotomy — Step-by-Step​

StepDetail
1. AnesthesiaIn a 58-patient office series, topical lidocaine-prilocaine (EMLA) was applied to the glans 1 hour before meatotomy.[13] A randomized trial of 76 boys aged 1.5–10 years compared EMLA under occlusion plus sedation with general anesthesia with or without dorsal penile block; 92–93% had no intraoperative pain across groups. The trial did not test EMLA alone.[12] The cited EMLA label's pediatric dose, area, and exposure limits apply to intact skin and do not establish a safe dose for meatal mucosa, where absorption is faster. The label says not to use the cream in neonates born before 37 weeks or infants under 12 months receiving methemoglobin-inducing drugs; infants under six months are especially susceptible to methemoglobinemia. Assess dosing for the application site.[31]
2. PositioningSupine; glans and meatus prepped with antiseptic
3. Crush and incisePlace a fine straight hemostat into the meatus along the ventral midline (6 o'clock) — one jaw inside the urethra, one on the ventral glans. Close for 30–60 seconds to crush and pre-hemostase the line. Sharp incision with fine scissors along the crushed line opens the meatus ventrally
4. ExtentOpen the stenotic segment to healthy tissue; choose caliber for the child’s age or adult anatomy and the extent of disease, rather than a fixed incision depth
5. HemostasisPrimary hemostasis from the crush; electrocautery or silver nitrate for any persistent bleeders
6. MaturationIn sutured meatoplasty, approximate mucosa to glans epithelium with fine absorbable suture.
7. PostoperativeTopical antibiotic ointment or petroleum jelly to the meatus 1–2 weeks; gentle meatal spreading 2–3× daily for several weeks to prevent re-adhesion

Meatoplasty Techniques​

Standard ventral meatoplasty​

A ventral incision through the stenotic meatus, excision of fibrotic tissue, and suture approximation of urethral mucosa to glans skin to create a wider, stable opening, the most commonly performed technique for post-circumcision meatal stenosis in children.[1]

For formal meatoplasty performed under anesthesia rather than in the office, the ventral incision should not be extended beyond the corona. The crushed lateral "dog ears" are recrushed and trimmed to create a broader V-shaped ventral defect, and three interrupted fine absorbable sutures are placed in the glans at the 4, 6, and 8 o'clock positions to evert the mucosa and fix the meatus open.[29]

Y-V meatoplasty (Sennert / Hadidi 2025)​

A technique specifically designed for ring meatal stenosis after hypospadias repair. The fundamental principle is to interrupt the circumferential scar ring by interposing a V-shaped flap of healthy glans tissue, with the aim of reducing recurrent ring contracture.[6]

Steps:

  1. Inverted V flap design. A small inverted-V flap is outlined adjacent to the meatus with its apex at the stenotic opening; each limb 3–5 mm.
  2. Flap elevation. The V flap is raised from underlying glans, preserving the basal blood supply.
  3. Stenotic ring excision. A wedge of the narrowed meatus underneath the elevated flap is excised, creating a wide patent meatus.
  4. V advancement. The flap tip is advanced distally into the widened meatus and sutured to the angle, converting the Y-shaped incision into a V-shaped closure.
  5. Scar-line interruption. The interposed V breaks the circumferential suture or scar line, minimizing further ring contraction.

Outcomes. Sennert / Hadidi reported symptom relief in 55/57 patients and two reoperations, with median follow-up four years (range three months to eight years). This single-center retrospective series has no concurrent comparator.[6]

Kim & King 1992 precursor. An earlier related technique described a V-shaped glans flap with apex at the dorsum of the meatus, with the stenosis incised along the back wall of the urethra into non-inflamed tissue and the flap tip sutured to the distal extent of the incision (penile-base tourniquet during the procedure). Anchors healthy tissue across the stenotic area; recurrent stenosis after this maneuver was reported as unusual.[28]

Jordan ventral preputial flap meatoplasty (Fiala 2003)​

A pedicled ventral preputial skin flap on a dartos pedicle can reconstruct selected adult meatal and distal urethral strictures when genital skin is suitable. The AUA strongly recommends against genital skin for reconstruction in LS-proven stricture .[11] See Jordan Fasciocutaneous Ventral Penile / Preputial Island Flap. Fiala 21-pt series: 100% success at mean 35 mo, no recurrence, no spray during micturition, and cosmetic satisfaction.[14]

Extended meatotomy (first-stage Johanson maneuver)​

For strictures extending into the fossa navicularis, lay the ventral urethra open from meatus through the entire strictured segment and marsupialize the urethral mucosa to adjacent skin edges, creating a hypospadiac meatus.[15] Morey 2007 reports 87% success (14/16) in complex or reoperative fossa-navicularis strictures within a 40-patient series (mean follow-up 52 months).[15] In the same series, onlay reconstruction succeeded in 10/11 short (2.5 cm or less) isolated strictures and 7/13 longer strictures.[15] The AUA 2023 amendment notes that extended meatotomy combined with high-dose topical steroids may reduce recurrence in LS strictures.[11][15]

Malone V-relief technique for LS​

Dorsal and ventral meatotomies with an inverted-V relieving incision dorsally to correct puckering, which avoids creating a hypospadiac meatus. Malone's 19-patient series reported no observed recurrences at a mean 45 months; two patients died and two were lost to follow-up. Among 13 questionnaire respondents, 11 (85%) reported no or only occasional spraying.[16]

BMG meatoplasty / fossa-navicularis urethroplasty​

Reserved for recurrent or complex meatal or fossa-navicularis strictures, particularly LS-associated. Before adult distal urethroplasty, obtain a urine culture and treat bacteriuria; give intraoperative antibiotic prophylaxis, a strong EAU recommendation for urethral surgery.[38] Multiple approaches:

ApproachnSuccessFollow-UpReference
Dorsal inlay BMG (Zumstein)3222/32 (69%) without symptomatic need for instrumentationMedian 42 mo; estimated recurrence-free survival 79% at 12 mo and 74% at 24 mo[17]
Sliding-T dorsal inlay (Hoare / Rourke)2725/27 (approximately 93%) passed a 16 Fr cystoscopeMean 29.6 mo; 96.3% satisfaction assessed at approximately 6 mo; 70.4% LS[18]
Transurethral ventral inlay (Sterling / Nikolavsky)4442/44 (95%) patent without additional interventionMean 36 mo; Qmax, PVR, IPSS and QoL significantly improved[19]
Transurethral dorsal inlay (Farrell)1693.8% anatomic / 100% functional28.8 mo; avoids glans splitting[20]
Circumferential buccal graft with glans-sparing transurethral excision (Ehlers / Figler; severe meatal / fossa-navicularis strictures)Not reported (technical video)Not reportedNot reported[21]

Outcomes by Clinical Context​

Pediatric post-circumcision meatal stenosis​

In a retrospective series of 22 boys (mean follow-up 12 months), uroflowmetry improved after meatoplasty: Qmax 9.7 to 16.4 mL/s (p = 0.001) and PVR 19.3 to 13.9 mL (p = 0.01).[22] Of the 19 boys with an abnormal preoperative flow pattern, 88% had a bell-shaped pattern afterward.[22] In a prospective study of 25 boys after meatotomy, 15 were fully evaluable at a mean 43 months; 12/15 had complete symptom resolution and 12/15 had an open-appearing meatus.[23] The authors concluded that symptom evaluation and physical examination suffice for postoperative assessment and that routine uroflowmetry does not change management.[23]

Post-hypospadias meatal stenosis​

In Bashi’s selected follow-up cohort, 63 of 112 eligible patients were analyzed: 45 required one meatoplasty and 18 required repeat surgery, with resolution reported after the final procedure. Of the 18 recurrences, approximately 28% occurred within one year and 39% at five years or later.[7]

Adult distal urethral strictures​

Treatment depends on anatomy and cause: an initial uncomplicated meatal stricture may be treated by meatotomy or dilation, while recurrent disease, LS, or prior hypospadias repair may warrant primary reconstructive assessment. For men with meatal or fossa-navicularis/distal strictures, the EAU 2026 guideline weakly recommends offering open meatoplasty or distal urethroplasty.[33] The selected technique groups report success percentages without comparing a sequence of meatotomy, meatoplasty and graft.[9][11] After distal urethroplasty, the EAU recommends at least one year of routine follow-up , flexible cystoscopy at three months , and a risk-adjusted schedule ; penile and graft/flap repairs are in its standard-risk group.[35]

Combined outcomes table​

SeriesProcedureSuccessFollow-upPopulation
Meeks 2012[9]Simple meatotomy87%61 mo (whole cohort)Adults (n = 73)
Morey 2007[15]Extended meatotomy (Johanson)14/16 (87%)52 mo (whole 40-patient cohort)Adults (n = 16 in meatotomy subgroup)
Dothan 2023[2]Pediatric meatotomy11/1,906 reoperationsVariableChildren (n = 1 906)
Dothan 2023[2]Pediatric meatoplasty0/305 reoperationsVariableChildren (n = 305)
Sennert 2025[6]Y-V meatoplasty (post-hypospadias ring)55/57 (96.5%) symptom relief; 2 reoperationsMedian 4 yr (3 mo to 8 yr; 6/57 had no more than 1 yr of follow-up)Median age 53 mo (range 17 mo–44 yr; n = 57)
Fiala 2003[14]Jordan ventral preputial flap100%35 moAdults (n = 21)
Malone 2004[16]Dorsal and ventral with V-relief (LS)No observed recurrence; 11/13 reported no or only occasional sprayingMean 45 mo19 operated; two died and two were lost to follow-up

Lichen Sclerosus — Special Considerations​

For men and boys with LS-associated meatal stenosis persisting after guideline-conform topical treatment, the 2026 S3 guideline weakly suggests meatoplasty and weakly suggests against dilation except for palliation.[32] For LS urethral stricture causing mechanical problems with voiding or sexual intercourse, it strongly recommends oral-mucosal graft urethroplasty; for male LS surgery, it strongly recommends topical corticosteroid ointment before and after the procedure (usually clobetasol propionate 0.05%, for example four weeks before and 4–12 weeks after).[32] These surgical recommendations are consensus-based.[32] In a retrospective cohort of 382 boys circumcised for histologically confirmed LS, 40 (10%) required a later meatal procedure. Concurrent meatotomy did not show a protective association, although it was used more often in boys with glans or meatal involvement.[30]

  • Intraurethral steroids. In the small Potts cohort, 25/28 men did not require escalation of treatment; the study reported mean follow-up of 24.8 months.[24] Ongoing self-calibration and steroid use may be necessary. See the topical corticosteroid hub.[24]
  • Extended meatotomy plus topical steroids may decrease recurrence versus meatotomy alone.[11]
  • One-stage BMG urethroplasty for LS has a pooled recurrence rate of 10% (95% CI 6–14%), rising to 18% in studies with follow-up of 24 months or more. In long-term studies only, recurrence was higher in patients with LS (OR 1.83, p = 0.05).[25]
  • Genital skin is best avoided for flaps or grafts because of the predilection of LS to recur in it; oral mucosa is preferred.[26]
  • Perineal urethrostomy is a long-term option for extensive LS when consistent with the patient’s goals.[27] Patel reported success in 13/14 selected PU patients.[27] See Augmented Perineal Urethrostomy.
  • Long-term surveillance (and biopsy when indicated) due to potential association of LS with squamous cell carcinoma.[26]

Complications​

  • Restenosis. Risk depends on cause, reconstruction and follow-up.[2] Dothan’s 0.58% versus 0% figures measure pediatric reoperation.[2] Adult LS-associated disease has a different prognosis.[2][9]
  • Bleeding. Reported in 3/76 boys (approximately 4%) in a randomized pediatric meatotomy study.[12]
  • UTI after distal graft reconstruction. Farrell reported postoperative UTI in 4/16 (25%) men after transurethral dorsal-inlay BMG.[20]
  • Spraying of urinary stream. Particularly with hypospadiac configurations after ventral meatotomy.
  • Need for manual meatal spreading. 3.6% of children at the first postoperative visit (meatotomy cohort).[2]
  • Cosmetic outcome. Extended ventral meatotomy creates a hypospadiac meatus that may compromise glans cosmesis and cause urinary spraying.[37]

Prevention​

  • Petroleum jelly applied to the glans after circumcision was associated with reduced meatal-stenosis risk (RR 0.024; 95% CI 0.005–0.12) in a meta-analysis of three randomized trials.[3]
  • Pre-circumcision topical steroids in boys with LS. In Homer's retrospective cohort, 2/49 boys who later needed a meatal procedure and 49/151 who did not had received preoperative steroids.[8] A 2026 cohort could not establish whether perioperative steroids prevent meatal stenosis because prescribing varied and was related to disease severity.[36]

References​

1. Wang MH. Surgical management of meatal stenosis with meatoplasty. J Vis Exp. 2010;(45):2213. doi:10.3791/2213.

2. Dothan D, Noyman Y, Perez D, et al. Surgical treatment of meatal stenosis: lessons learned from the pediatric urology practice. Urology. 2023;171:201-204. doi:10.1016/j.urology.2022.08.006.

3. Morris BJ, Krieger JN. Does circumcision increase meatal stenosis risk? A systematic review and meta-analysis. Urology. 2017;110:16-26. doi:10.1016/j.urology.2017.07.027.

4. Shabanzadeh DM, Clausen S, Maigaard K, Fode M. Male circumcision complications — a systematic review, meta-analysis, and meta-regression. Urology. 2021;152:25-34. doi:10.1016/j.urology.2021.01.041.

5. Özen MA, Gündoğdu G, Taşdemir M, Eroğlu E. Are mechanical and chemical trauma the reason of meatal stenosis after newborn circumcision? Eur J Pediatr. 2019;178(1):77-80. doi:10.1007/s00431-018-3261-4.

6. Sennert M, Fawzy M, Wirmer J, Graumann C, Hadidi AT. Y-V meatoplasty: a simple novel technique to correct meatal stenosis. J Sex Med. 2025. doi:10.1093/jsxmed/qdaf236.

7. Bashi T, Rikover I, Kidron A, et al. Repair of meatal stenosis following hypospadias reconstruction. Urology. 2026. doi:10.1016/j.urology.2026.02.037.

8. Homer L, Buchanan KJ, Nasr B, Losty PD, Corbett HJ. Meatal stenosis in boys following circumcision for lichen sclerosus (balanitis xerotica obliterans). J Urol. 2014;192(6):1784-1788. doi:10.1016/j.juro.2014.06.077.

9. Meeks JJ, Barbagli G, Mehdiratta N, Granieri MA, Gonzalez CM. Distal urethroplasty for isolated fossa navicularis and meatal strictures. BJU Int. 2012;109(4):616-619. doi:10.1111/j.1464-410X.2011.10248.x.

10. Nabavizadeh B, Akbari P, Ladi Seyedian SS, Nabavizadeh R, Kajbafzadeh AM. Increased risk of atopic diseases in boys with meatal stenosis: a possible pathophysiological relation. J Pediatr Surg. 2020;55(3):490-492. doi:10.1016/j.jpedsurg.2019.07.011.

11. 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.

12. Ben-Meir D, Livne PM, Feigin E, Djerassi R, Efrat R. Meatotomy using local anesthesia and sedation or general anesthesia with or without penile block in children: a prospective randomized study. J Urol. 2011;185(2):654-657. doi:10.1016/j.juro.2010.09.119.

13. Cartwright PC, Snow BW, McNees DC. Urethral meatotomy in the office using topical EMLA cream for anesthesia. J Urol. 1996;156(2 Pt 2):857-859. doi:10.1097/00005392-199608001-00087.

14. 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.

15. 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.

16. Malone P. A new technique for meatal stenosis in patients with lichen sclerosus. J Urol. 2004;172(3):949-952. doi:10.1097/01.ju.0000134781.43470.5f.

17. 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.

18. 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.

19. 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.

20. Farrell MR, Campbell JG, Zhang L, Nowicki S, Vanni AJ. Transurethral reconstruction of fossa navicularis strictures with dorsal inlay buccal mucosa graft urethroplasty. World J Urol. 2022;40(6):1523-1528. doi:10.1007/s00345-022-03994-5.

21. Ehlers M, Figler BD. Excision and circumferential buccal graft for severe meatus and fossa navicularis strictures. Urology. 2020;146:304. doi:10.1016/j.urology.2020.09.008.

22. VanderBrink BA, Gitlin J, Palmer LS. Uroflowmetry parameters before and after meatoplasty for primary symptomatic meatal stenosis in children. J Urol. 2008;179(6):2403-2406. doi:10.1016/j.juro.2008.01.169.

23. Neheman A, Rappaport YH, Darawsha AE, Leibovitch I, Sternberg IA. Uroflowmetry before and after meatotomy in boys with symptomatic meatal stenosis following neonatal circumcision — a long-term prospective study. Urology. 2019;125:191-195. doi:10.1016/j.urology.2018.12.005.

24. Potts BA, Belsante MJ, Peterson AC. Intraurethral steroids are a safe and effective treatment for stricture disease in patients with biopsy-proven lichen sclerosus. J Urol. 2016;195(6):1790-1796. doi:10.1016/j.juro.2015.12.067.

25. Kurtzman JT, Blum R, Brandes SB. One-stage buccal mucosal graft urethroplasty for lichen sclerosus-related urethral stricture disease: a systematic review and pooled proportional meta-analysis. J Urol. 2021;206(4):840-853. doi:10.1097/JU.0000000000001870.

26. Chung ASJ, Suarez OA. Current treatment of lichen sclerosus and stricture. World J Urol. 2020;38(12):3061-3067. doi:10.1007/s00345-019-03030-z.

27. Patel CK, Buckley JC, Zinman LN, Vanni AJ. Outcomes for management of lichen sclerosus urethral strictures by 3 different techniques. Urology. 2016;91:215-221. doi:10.1016/j.urology.2015.11.057.

28. Kim KS, King LR. Method for correcting meatal stenosis after hypospadias repair. Urology. 1992;39(6):545-546. doi:10.1016/0090-4295(92)90013-m.

29. Routh JC. Pediatric meatotomy and distal reconstruction. In: Smith JA Jr, Dmochowski RR, Thomas JC, Preminger GM, eds. Hinman's Atlas of Urologic Surgery. 5th ed. Elsevier; 2025:998-1002.

30. Faily S, Chhabra S, Corbett HJ. "Meatal surgery at the time of circumcision for lichen sclerosus (LS/BXO) does not reduce the need for later meatal intervention: a retrospective cohort study." J Pediatr Surg. 2024;59(9):1846-1850. doi:10.1016/j.jpedsurg.2024.05.010

31. DailyMed. "Lidocaine and Prilocaine Cream USP, 2.5%/2.5%." PAI Pharma; 2025. Prescribing information.

32. Kirtschig G, Woelber L, Günthert A, et al. "Evidence- and consensus-based guideline on lichen sclerosus." J Dtsch Dermatol Ges. 2026;24(4):566-584. doi:10.1111/ddg.70000.

33. European Association of Urology. "EAU Guidelines on Urethral Strictures: Disease Management in Males." Limited update 2026, section 6.3.1.f. Guideline.

34. European Association of Urology. "EAU Guidelines on Urethral Strictures: Disease Management in Females." Limited update 2026, section 7.3.1. Guideline.

35. European Association of Urology. "EAU Guidelines on Urethral Strictures: Follow Up." Limited update 2026, sections 11.6–11.7. Guideline.

36. Balfour J, Elkassaby A, Mostafa MS. "Incidence and management of meatal stenosis in paediatric patients following circumcision for lichen sclerosus et atrophicus." Pediatr Surg Int. 2026;42:242. doi:10.1007/s00383-026-06477-5.

37. Dielubanza EJ, Han JS, Gonzalez CM. "Distal urethroplasty for fossa navicularis and meatal strictures." Transl Androl Urol. 2014;3(2):163-169. doi:10.3978/j.issn.2223-4683.2014.04.02.

38. European Association of Urology. "EAU Guidelines on Urethral Strictures: Perioperative Care of Urethral Surgery." Limited update 2026, section 10.2. Guideline.