Nikolavsky Urethroplasty for Distal Urethral Stricture in a Young Man With Severe Obesity and Lichen Sclerosus: A Surgical Approach to a Rare Presentation

This case report describes a rare occurrence of distal urethral stricture secondary to lichen sclerosus (LS) in a 19-year-old man, an inflammatory condition typically seen in older individuals. The patient had a medical history notable for recurrent urinary tract infections (rUTIs), phimosis, nephrolithiasis, and class III obesity (BMI 53.4). He presented with dysuria and incomplete bladder emptying, which mildly improved with tamsulosin. Physical examination revealed pinpoint meatal stenosis. Cystoscopy with retrograde urethrography demonstrated a 2.5-cm distal penile urethral stricture with a normal-appearing posterior urethra. A transurethral ventral buccal mucosa graft inlay urethroplasty (Nikolavsky urethroplasty) was performed as a single-stage operation. Postoperatively, the patient recovered well without complications and demonstrated marked improvement in urinary symptoms and resolution of rUTIs during follow-up, with no need for additional interventions. The patient's history of rUTIs likely accelerated stricture progression by worsening the inflammatory response associated with LS. This case highlights the potential contribution of severe obesity as a risk factor for LS and urethral strictures and underscores the importance of considering LS as a possible etiology in younger patients. It also supports the efficacy of buccal mucosa grafts as a durable and effective approach for complex urethral reconstruction.