Presented by: Kunal Jain MD
University of Manitoba, Section of Urology

Introduction

We explore the historical origins and developments in dilation and urethrotomy for the treatment of urethral stricture disease (USD).

Materials

Primary and secondary sources related to USD were reviewed and put into perspective within current practices.

Results

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The earliest known treatment for USD is from the Ayurveda, when its founder used urethral dilators lubricated with ghee. By 200 BC, Erasistratus of Greece developed S-shaped metal catheters. These catheters were adapted and modernized by the Romans who used lead and bronze dilators. It was not until the first recorded epidemic of gonorrhea in 1520 AD when a renewed focus on USD arose and a primitive form of internal urethrotomy was developed. The introduction of the lanceolate-shaped catheter in 1795 AD allowed for successful internal urethrotomy and paved the future for the development of later internal urethrotomes. It was only in 1996 AD when Freid and Smith described a method which used a guidewire for cannulation of the urethra and then dilation overtop with a Seldinger technique. In 1997 AD, Steenkamp et al. published a landmark trial demonstrating equivalent outcomes between filiform dilation and direct visual internal urethrotomy. In 2007, Herschorn of Canada introduced S-shaped coaxial urethral dilators, and four years after that, Gelman et al. described direct vision balloon dilation. Recently, drug-coated balloon dilation is being investigated.

Conclusion

The origins of endoluminal treatment of USD can be traced back to over twenty-six centuries ago. Current guidelines rely on limited and dated evidence. We demonstrate that this field is ripe for further advancements.

Funding

None.

Lead Authors

Thomas Southall, MD
University of Manitoba, Section of Urology

Co-Authors

Suvig Dua, BSc
University of Manitoba, Max Rady College of Medicine

David Chung, MD
University of Manitoba, Section of Urology

Ryan Ramjiawan, MD
University of Manitoba, Section of Urology

Jasmir Nayak, MD, FRCSC, FACS
University of Manitoba, Section of Urology

Premal Patel, MD, FRCSC, FACS
University of Manitoba, Section of Urology

Umesh Jain, MBBS, MS, FRCSC
University of Toronto, Department of Urology (St. Joseph's Health Centre)