Year : 2011 | Volume
: 27 | Issue : 3 | Page : 303--304
Urethral stricture disease - Have we found the magic wand?
Nitin S Kekre
Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India
Nitin S Kekre
Department of Urology, Christian Medical College, Vellore, Tamil Nadu
|How to cite this article:|
Kekre NS. Urethral stricture disease - Have we found the magic wand?.Indian J Urol 2011;27:303-304
|How to cite this URL:|
Kekre NS. Urethral stricture disease - Have we found the magic wand?. Indian J Urol [serial online] 2011 [cited 2020 Jul 5 ];27:303-304
Available from: http://www.indianjurol.com/text.asp?2011/27/3/303/85417
Urethral stricture disease is as old as mankind. In ancient India, Susruta described the use of a reed catheter lubricated with ghee. , I recall the late Professor John Blandy stating that gentle urethral dilatation is the best option for a urethral stricture. Better understanding of the pathophysiology of stricture disease, with recognition of spongiofibrosis, advances in the field of urethral imaging, and principles borrowed from the experience of the plastic surgeon, has revolutionized the management of this complex problem. Early enthusiasm about the endoscopic cold knife and later LASER urethrotomy is gradually settling. As Loughnane stated more than half a century ago - 'Internal urethrotomy is an operation of choice, not of necessity, and by itself does not cure.' Urologists now realize that endoscopic urethrotomy is rarely curative and the patient often needs repeated procedures or regular self-calibration. This is not surprising, as a urethral stricture is a scar in the underlying epithelium and adjacent tissues, which needs to be excised and replaced by healthy epithelium to achieve a cure. The history of surgery of urethral stricture is replete with many such procedures using partial thickness skin grafts or pedicles from the penile or scrotal skin. Most, ultimately fail over a period of time. Although the use of buccal mucosa in urology was initially described by Humby,  it was after Burger  et al.'s description, in 1992, that it began to be widely used. In 1996 Guido Barbagali et al.  described the use of the dorsal onlay graft, using buccal mucosa. The special characteristics of the buccal mucosa made it a better substitute for urethral reconstruction and subsequent publications led us to believe that we had found the magic wand, which would cure this crippling malady. However the long-term results of this procedure have highlighted its limitations. The quality of the different publications too is questionable, as the authors have used different criteria to define success. It is not surprising, therefore, that controversy continues unabated about the technique - ventral, lateral or dorsal onlay; single stage or two stage. Moreover, how should one manage failure following buccal mucosa substitution? In a recent publication in Lancet, Anthony Atala et al., from the Wake Forest University have reported the use of stem cells in the reconstruction of the urethra in children with post-traumatic urethral defects.  These results appear encouraging. Would a tailor-made urethra from the patients' own stem cells be the ultimate solution? Till that happens, however, we may still have to continue with the age-old urethral dilatation in certain cases. In this issue, Dr. Deepak Dubey and other experts have provided an in-depth review of most of the relevant topics in urethral reconstruction. I express my sincere gratitude to Dr. Dubey and his team for their contribution.
Video Section of IJU: As indicated in my earlier communication, we are introducing the video section from this issue. It has been the effort of the editorial team to improve readability of our Journal and make it more useful for a practicing urologist. There are three invited videos for the current issue. Modi et al. demonstrate their technique of retroperitoneoscopic ureterolithotomy, Mandhani A shows us a simple, but useful technique of stenting after ureterolithotomy, while Ahlawat's video details the steps for removing hilar renal tumors laparoscopically. I am sure the viewer will enjoy these video clips. Although, more importantly you all are welcome to submit videos of eight-minute duration with voice / commentary, with or without background music, in MPEG 2 or Audio Video Interleave (AVI) format, in NTSC / PAL video standard, along with a write-up of 500 words describing the salient steps of the procedure. The video should also have cartoons or line diagrams, to elaborate the surgical steps. This will follow the same peer reviewing process as our other articles do. The write-up should be uploaded in the journal website as 'IJU videos' and DVDs containing the video should be sent to Dr. Anil Mandhani, Additional Professor, Department of Urology, SGPGIMS, Lucknow-226014, UP, India.
This is just a beginning and in a broader perspective, our focus will be to provide a gamut of surgical procedures being performed by urologists. I remain optimistic that this section will grow and we will in future, be able to launch a video journal, which would showcase the skills of Indian urologists on an international platform. So get, set, go.
The editorial team would be very happy to hear your comments and feedback on this venture.
With best wishes,
|1||Blandy JP. Urethral stricture. Postgrad Med J 1980;56:383-418.|
|2||Das S. Urology in ancient India. Indian J Urol 2007;23:2-5. |
|3||Loughnane F McG. Textbook of Genitourinary Surgery. In: Winsbury-White HP, editor. Edinburgh: Livingstone; 1948. p. 638.|
|4||Humby G. A one-stage operation for hypospadias. Br J Surg 1941;29:84- 92.|
|5||Burger RA, Muller SC, el-Damanhoury H, Tschakaloff A, RiedmillerH, Hohenfellner R. The buccal mucosal graft for urethral reconstruction: A preliminary report. J Urol 1992;147:662-4.|
|6||Barbagli G, Selli C, Tosto A, Palminteri E. Dorsal free graft urethroplasty. J Urol 1996;155:123-6.|
|7||Raya-Rivera A, Esquiliano DR, Yoo JJ, Lopez-Bayghen E, Soker S, Atala A. Tissue-engineered autologous urethras for patients who need reconstruction: An observational study. Lancet 2011;377:1175-82.|