ANTEGRADE-RETROGRADE URETHROTOMY FOR TREA TMENT OF HIGH-GRADE URETHRAL STRICTURE

In the case of urethral stricture which is non-passable by conventiona l ''cold knife'' urethrotomy, open urethroplasty can be avoided by com bined antegrade-retrograde urethrotomy (ARUT). A rigid cystoscope is g uided, through a dilated, suprapubic cystostomy channel, to the strict ure in the membranous or bulbular urethra. A urethrotome is inserted i n the retrograde direction and the ''cut to the light'' procedure is a dopted. Using the ARUT method, successful realignment was achieved in 9 patients; 4 strictures were trauma- or urethritis-induced and 5 were the result of transurethral management. Recurrent stricture in 4 out of 7 cases (57%) required further urethrotomy. There was no recurrence in 4 out of 7 patients for at least 5 months subsequent to the last t reatment. All patients were spared open surgery. - The antegrade-retro grade technique exists since 1978. Up to date, 63 cases have been ment ioned in the literature. The primary therapy success rate is 25%. Succ essful retreatment following recurrence was observed in 65%. We recomm end ARUT as first-choice treatment for severe strictures of the bulbul ar and membranous urethra.