The evolution of urethroplasty for urethral strictures

Ivaz S1, Bugeja S1, Frost A1, Jeffery N1, Dragova M1, Mundy A1
1UCLH, London, United Kingdom

Until Hunter recognised strictures to be areas of narrowing of the urethra, as we now know them, urethral obstruction was ascribed to 'carnosities' that grew into the urethra, as described as such by Galen (131-200). Treatment was by dilatation or catheterisation and had been since at least 3,000 BC. There was not true attempt at urethroplasty until the late 19th century. Heusner reported the first successful urethroplasty in 1883 in Germany, and Robson was the first to describe it in English in 1885. Russell, in 1915, described excision of a stricture and dorsal semi-circumferential anastomosis leaving the ventral aspect open as a temporary perineal urethrostomy until healing was complete. Marion described the first attempt at mobilisation of the two ends of the urethra to perform an anastomosis in 1940. This problem of the length of the stricture was overcome by Davis and Traut in 1926 who described how a buried epithelialised strip become a tube, assuming the strip was open to the surface at each end. The first attempt at closing the marsupialised strip of epithelium with a flap of local skin was by Guy and Wyland Leadbetter in 1962. It was, however, Orandi who first described how that penile or scrotal skin-flap could be mobilised widely on a dartos pedicle to deal with a stricture of any length. Humby in 1941 described the repair of hypospadias using a graft of buccal-mucosa. Devine and Horton popularised the use of full-thickness skin-grafts in 1961. Contemporary urethroplasty still relies on these techniques.