title: Antegrade-retrograde urethrotomy for treatment of severe strictures of the urethra: experience and literature review.
abstract: In cases of urethral stricture that are nonpassable when using conventional internal urethrotomy, open urethroplasty can be avoided by performing combined antegrade-retrograde urethrotomy (ARUT). A rigid cystoscope is guided through a dilated suprapubic cystostomy channel toward the stricture in the membranous or bulbar urethra. A urethrotome is inserted in retrograde fashion, and the "cut to the light" procedure is performed. Using the ARUT method, realignment was achieved in nine patients; four of whom had strictures induced by trauma or urethritis and five of which were the result of previous transurethral management. Recurrent stricture in four of seven cases necessitated further urethrotomy. There was no recurrence in five of seven patients for at least 5 months subsequent to the last treatment. All patients were spared open surgery. The antegrade-retrograde technique was described in 1978, but to date, only 70 cases have been reported in the literature. The primary success rate is 25%. Successful retreatment following recurrence was observed in 65%. We recommend ARUT as a first-choice treatment for severe strictures of the bulbar and membranous urethra.
authors.affiliation: Department of Urology, Klinikum Mannheim of University of Heidelberg, Mannheim, Germany.
authors.forename: K U
authors.initials: KU
authors.lastname: Köhrmann
authors.forename: T O
authors.initials: TO
authors.lastname: Henkel
authors.forename: P
authors.initials: P
authors.lastname: Schmidt
authors.forename: J
authors.initials: J
authors.lastname: Rassweiler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003559:Cystostomy; D004724:Endoscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation; D016896:Treatment Outcome; D014521:Urethra / Q000473:pathology / Q000502:physiology / Q000601:surgery*; D014525:Urethral Stricture / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D014546:Urinary Catheterization