Sequential Surgical Approach for Coexisting Meatal Stenosis, Buried Penis, and Urethral Stricture in 37 Years Old Male

Abstract

Background: Meatal stenosis, buried penis, and urethral stricture are recognized causes of lower urinary tract obstruction (LUTO). The coexistence of these three conditions in a young adult is exceedingly rare and presents a diagnostic and therapeutic challenge because both distal and proximal obstructive components may contribute to urinary dysfunction. A staged surgical approach is often required to restore urinary function while minimizing complications. Objective: To describe the clinical presentation, diagnostic evaluation, staged surgical management, and clinical outcomes of a young adult with concurrent meatal stenosis, buried penis, and urethral stricture. Methods: This study is a descriptive case report. The subject was a 27-year-old male diagnosed with concurrent meatal stenosis, buried penis, and urethral stricture. Clinical data were retrospectively collected from medical records, including patient history, physical examination, diagnostic investigations, operative procedures, postoperative management, and follow-up evaluations. Data were analyzed descriptively and compared with the current literature. Results: A 27-year-old man presented with chronic progressive weak urinary stream and incomplete bladder emptying. Clinical evaluation revealed buried penis with meatal stenosis, while further assessment identified concomitant urethral stricture as an additional cause of bladder outlet obstruction. A staged management strategy was implemented, beginning with dorsal slit circumcision and subcutaneous suprapubic lipectomy to relieve distal obstruction and correct the buried penis. Penile reconstruction with skin graft viability assessment was subsequently performed. Persistent urethral narrowing required urethral dilatation. During follow-up, the patient developed epididymo-orchitis, which was successfully treated with antibiotic therapy without compromising the reconstructive outcome. At the final follow-up, the patient demonstrated significant improvement in urinary flow and resolution of obstructive urinary symptoms, with satisfactory functional outcomes. Conclusion: The coexistence of meatal stenosis, buried penis, and urethral stricture represents a rare and complex cause of lower urinary tract obstruction. Comprehensive evaluation and a staged reconstructive approach tailored to the level of obstruction can achieve favorable functional outcomes while minimizing postoperative complications. This case highlights the importance of identifying all contributing obstructive lesions before definitive surgical intervention.