ANTEGRADE RETROGRADE URETHROTOMY FOR TREATMENT OF SEVERE STRICTURES OF THE URETHRA - EXPERIENCE AND LITERATURE-REVIEW

In cases of urethral stricture that are nonpassable when using convent ional internal urethrotomy, open urethroplasty can be avoided by perfo rming combined antegrade-retrograde urethrotomy (ARUT). A rigid cystos cope is guided through a dilated suprapubic cystostomy channel toward the stricture in the membranous or bulbar urethra. A urethrotome is in serted in retrograde fashion, and the ''cut to the light'' procedure i s performed. Using the ARUT method, realignment was achieved in nine p atients; four of whom had strictures induced by trauma or urethritis a nd five of which were the result of previous transurethral management. Recurrent stricture in four of seven cases necessitated further ureth rotomy. There was no recurrence in five of seven patients for at least 5 months subsequent to the last treatment. All patients were spared o pen 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 recurren ce was observed in 65%. We recommend ARUT as a first-choice treatment for severe strictures of the bulbar and membranous urethra.