History of Urethral Stricture and Its Management From the 18th to 20th Century

Summary

Urethral stricture management has evolved greatly over the last two centuries. We have come along way from the use of wax casts, caustics, cauterization, external urethrotomy, and stricture chairs. However, as much as we have advanced, we still actively utilize dilation and urethrotomy in current practice. Urethroplasty surgery stands on the shoulders of pioneering giants, such as Denis Browne, Hamilton Russel, Begnt Johanson, and Charlie Devine. For the second half of the 20th century, the urethral reconstruction pendulum has swung from mainly two-stage urethroplasty, then to grafts, then onto fasciocutaneous flaps, and currently, has swung back to grafts (buccal mucosa). Great promise lies with tissue engineering and regenerative medicine today. However, to know where we are going, it is often helpful to know where we have been.

Appendix

1.1 Preferred Instruments of EL Keys (circa 1905)

• Conical steel sounds, Nos. 15 to 33, preferably

• double taper from 24 up

• Several whalebone filiform guides

• Conical woven french bougies, sizes 5 to 18

• Set of bulbous or blunt sounds, or a Urethrometer

• Instillation syringe and Aspirator

• Conical woven olivary catheters, small and large

• One silver catheter, No 6, tunneled

• Steel sounds

• Otis or Maisonneuve urethrotome

• Soft rubber catheter and a female catheter

• Blunt pointed straight bistoury

• Heavy soft -rubber perineal tube

• Bottle of 10% nitrate of silver solution.

• Clover's crutch.

• (From: Keyes EL, (1905) The Surgical Diseases of the Genitor-urinary Organs, New York and London, D Appleton and Co, pgs. 226–227.)