History of Urethroplasty

Timeline by Sanjay B Kulkarni MS, FRCS and Mang L Chen, MD

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History of Urethral Stricture Management

1

Ancient India Susruta:urethral dilation with reed catheter lubricated with ghee.

Greece, Socrates: record of his joking about patients weak flow

Greece, Epicurus: committed suicide when he could no longer dilate his stricture.

Rome in the first century, Celsus: described external urethrotomy for treatment of a stone impacted behind a stricture

Arabia: preserved urethrotomy thru many years but was then lost

1510-1590: Ambroise Pare brought back urethrotomy; invented instrument for scraping “carnosities” from the urethra.

1795: Silver catheters with concealed lancets were used for urethrotomy

1817: Civiale of Paris invented a practical internal urethrotome

1825: James Guthrie English military surgeon described urethral dilation

1848: Maisonneuve improved the internal urethrotome by adding a filiform guide.

(Gonorrhoea: caused inflammatory strictures that affected Henry IV and Napolean)

1875: Fessenden Otis, a professor of genito-urinary diseases at the New York College of Physicians and Surgeons, described the use of the “urethra-meter” to determine the appropriate size of sound and bougie for urethral dilation

Oral Mucosa Grafts for Urethroplasty

1894: Sapezhko performed urethroplasty with oral mucosa

1902: Tyrmos used oral mucosal grafts for urethral fistula

1941: Humby used oral mucosa in an 8 yr old boy with a failed hypospadias repair

1992: Burger et al. oral mucosa graft urethroplasty in dogs and in small clinical series

1992: Dessanti et al. reported on the use of bladder and oral mucosa for hypospadias repair

1993: El-Kasaby et al. lower lip oral mucosa graft harvest

1996: Morey and McAninch gave a detailed description of harvest technique of buccal mucosa grafts and described BMG ventral onlay urethroplasties for bulbar strictures

Penile Urethra Reconstruction

1953: Johanson staged repair of urethral strictures without oral mucosal grafts

1999: Hayes and Malone used buccal mucosa graft for dorsal inlay in hypospadias patients

2000: Kulkarni et al described penile invagination to treat anterior and panurethral strictures

2001: Asopa et al used BMG dorsal inlay in adults for one-stage urethroplasty

Bulbar Urethra Reconstruction

1996: Morey and McAninch gave a detailed description of harvest technique of buccal mucosa grafts and described BMG ventral onlay urethroplasties for bulbar strictures

1996: Barbagli et al described dorsal onlay BMG bulbar urethroplasty

1998: Iselin and Webster reported on anastomotic repair with graft augmentation of the dorsal urethra

2006: Barbagli et al used fibrin glue in urethroplasty

2008: Barbagli et al reported on bulbospongiosus muscle and nerve sparing bulbar reconstruction

Panurethral Stricture Urethroplasty

1953: Johanson two-stage urethroplasty: ventral opening of penile urethra with 2nd stage retubularization 6 months later

1993: McAninch et al circular fasciocutaneous flap harvested from hairless penile skin

2000: Kulkarni et al penile invagination technique with dorsal BMG onlay

2009: Kulkarni et al one-sided penile invagination technique to preserve lateral blood supply to urethra

2010: Barbagli et al supported perineal urethrostomy with Blandy flap technique for complex urethral strictures or patients unfit for definitive surgery

Posterior Urethral Stenosis Reconstruction

1962: Pierce et al total abdominal pubectomy for exposure of posterior urethra

1968: Paine and Coombes end-to-end anastomosis after resection of scar and pubic bone (abdominal approach)

1973: Waterhouse et al combined abdomino-perineal approach

1976: Turner-Warwick used omental wrap for the transpubic primary anastomosis

1986: Webster and Goldwasser perineal anastomotic urethroplasty via infrapubectomy

2010: Kulkarni et al etiology and treatment of posterior urethral trauma in India and Italy

References

  • Blandy JP. Urethral Stricture. Postgraduate Medical Journal (June 1980) 56, 383-418.

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