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INTRODUCTION AND OBJECTIVES: Urethral stricture is a prevalent and challenging urological condition. Management has evolved over the last century, specifically with the advent of oral mucosal grafts for urethroplasty. We review the history of urethral stricture treatment.

METHODS: A literature search of medical texts, journal articles and historical texts was performed pertaining to history of urethral strictures.

  • Urethra ~ greek word ourein = to urinate
  • Urethral stricture – Hindoo scriptures 6th century BC
  • Ayurveda – urethral dilatation using metal / wood dilators
  • Ambrose Pare’s description – ‘A silver weir, sharp at the upper end, is to be passed in as far as the obstruction, then by oft thrusting it in and out, it may wear and make plain the resisting caruncles‘. 1894 Sapezho – first described oral mucosa in urethroplasty
  • Anterior urethra –
    • 1953 Staged repair Johanson
    • 1996 Dorsal onlay Barbagli
    • 1996 Ventral onlay Morey McAnnich
    • 1999 Dorsal inlay penile Hayes & Malone
    • 2000 Panurethral Kulkarni
    • 2001 Dorsal inlay bulbar Asopa
    • 2008 Muscle and nerve sparing Barbagli
    • 2010 Enterourethroplasty Mundy
    • 2015 NTAU Mundy

     

  • Oral mucosal grafts still remains one of the greatest advancements in urethral stricture management.

In the future urethroplasty may have a limited role once we establish how to halt the process of fibrosis

Posterior urethral injuries (PFUI) have been traditionally managed by Anastomotic Urethroplasty

Posterior Urethra –

  • 1962 Pierce. Total abdominal pubectomy
  • 1968 Paine & Coombs Abdominal approach
  • 1973 Waterhouse Abdominoperinal approach
  • 1976 Turner-Warwick Transpubic approach with omental wrap
  • 1986 Webster & Goldwasser Perineal approach
  • 2010 Kulkarni Etiology and management of PFUI

Future directions –

Anterior urethra

  • Liquid mucosal grafts
  • Tissue engineering

Posterior urethra

  • Stepwise perineal approach

 


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