Opinion: Endoscopic Urethrotomy

Urethral stricture is one of the most difficult urological problems to heal adequately and many surgical and no surgical techniques have been described to its management. Reports has been documented in ancient literature of the Hindus, Egyptians and Greeks (1). In 1957, Ravasini described the internal urethrotomy under direct vision and used electrocautery to incise the stricture. In 1971, Sachse introduced the sharp-bladed cold-knife urethrotome under direct vision, reporting 80% success rate with this procedure in 1974 (1, 2). Since this description by Sachse, the direct vision internal urethrotomy (DVIU) became one of the most popular treatments on the management of urethral strictures. The male anterior urethra stricture is characterized by a fibrotic process which achieves varying degrees of peri-urethral spongiosum tissue fibrosis (spongiofibrosis) associated with a decrease in urethral caliber and consequently in the urine flow. Endoscopic treatment is based on the deep incision of the fibrotic area and subsequently local reepithelization process to the maintenance of the urethral patency. Data from the National Health Service in the UK during 2006 showed that the DVIU or urethral dilatation was used in 93% of cases and urethroplasty in 7% of cases (1). In a nationwide survey in the Netherlands, the DVIU was practiced by 97% of urologists. Urethroplasty was performed at least once yearly by 23%, with only 6% performing more than five urethroplasties annually (3). A similar date was observed from an US survey. Most urologists (63%) treat between 6-20 urethral strictures per year. The most common minimally invasive procedures used for anterior urethral strictures managing were urethral dilation (92.8%), cold-knife optical internal urethrotomy (85.6%), endourethral stents (23.4%), laser urethrotomy (19%), and periurethral steroid injection after urethrotomy (7.9%) (4). During the 80’s and 90’s decades, many authors have published very interesting rates of success for the endoscopic management of anterior urethral strictures and helped Difference Of OpiniOn