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Re: Reconstruction of the Male Urethra in Strictures
european urology 51 (2007) 1139–1143
available at www.sciencedirect.com journal homepage: www.europeanurology.com
Words of Wisdom
Re: Reconstruction of the Male Urethra in Strictures Johanson B Acta Chir Scand Suppl 1958 1953;176:1–103. Expert’s summary: Johanson described a technique for treating urethral strictures developed from Denis Browne’s technique of hypospadias repair [1]. The basic principle had been developed initially by Duplay in 1880: A strip of epithelium (in this case skin or urethra), buried under the skin surface but open at both ends, will develop into a tube. In Johanson’s own technique he first marsupialised the strictured urethra and then, at least 6 wk later, he created a urethral plate from a 2- to 2.5-cm wide strip of the marsupialised area between the proximal urethrostomy and the distal urethrostomy or the external meatus, according to the distal extent. This strip would obviously be part urethra and part skin, depending on how much urethra remained from the strictured segment. He then closed the skin carefully over the buried strip with an indwelling catheter to act as a scaffold for the tubular neourethral tube to form around. The catheter was removed 10 d or so later. He treated 36 patients with this method; at the time of this report, 33 were available for follow-up with a follow-up period ranging from 2 to 20 mo and averaging 10 mo. At the time of follow-up, 22 patients were in satisfactory condition, as judged by urethrography and urethroscopy. Nine patients had required reoperation. Expert’s opinion: The other important paper is from John Swinnney [2]. He used almost the same technique as Johanson’s and started at about the same time, but his paper is 0302-2838/$ – see back matter
doi: 10.1016/j.eururo.2007.01.054
less well-known. Their techniques—in fact—are almost irrelevant. The point of their publications is that they represent the first consistent attempt to try and treat urethral strictures curatively if the patient would otherwise need frequent and lifelong dilatation or urethrotomy. Nowadays, with better urologic care and the routine use of antibiotics, it is easy to underestimate the misery that many patients endured in the past, from a lifetime of dilatation of their urethral strictures and with the common need for frequent instrumentation, often accompanied by bleeding and sepsis. The efforts of Swinney and Johanson, developed from the Dennis Browne principle, and developed by others, notably Ledbetter [3] and Turner-Warwick, put an end to all this [4]. The Duplay-Dennis Browne-Johanson-Swinney procedure is rarely used now as a matter of choice, but as a result of these surgeons’ pioneering efforts the problems of stricture patients are now amenable to cure when instrumentation is only palliative and when a lifetime of instrumentation might be their only alternative.
References [1] Browne D. An operation for hypospadias. Lancet 1936;i: 141–3. [2] Swinnney J. Urethroplasty: an assessment after seven years experience. Br J Urol 1957;29:293–7. [3] Ledbetter GW. A simplified urethroplasty for strictures of the bulbous urethra. J Urol 1960;83:54–9. [4] Turner-Warwick RT. A technique for posterior urethroplasty. Urol 1960;83:416–21.
A.R. Mundy Institute of Urology, London, UK DOI:10.1016/j.eururo.2007.01.055
available at www.sciencedirect.com journal homepage: www.europeanurology.com
Words of Wisdom
Re: Reconstruction of the Male Urethra in Strictures Johanson B Acta Chir Scand Suppl 1958 1953;176:1–103. Expert’s summary: Johanson described a technique for treating urethral strictures developed from Denis Browne’s technique of hypospadias repair [1]. The basic principle had been developed initially by Duplay in 1880: A strip of epithelium (in this case skin or urethra), buried under the skin surface but open at both ends, will develop into a tube. In Johanson’s own technique he first marsupialised the strictured urethra and then, at least 6 wk later, he created a urethral plate from a 2- to 2.5-cm wide strip of the marsupialised area between the proximal urethrostomy and the distal urethrostomy or the external meatus, according to the distal extent. This strip would obviously be part urethra and part skin, depending on how much urethra remained from the strictured segment. He then closed the skin carefully over the buried strip with an indwelling catheter to act as a scaffold for the tubular neourethral tube to form around. The catheter was removed 10 d or so later. He treated 36 patients with this method; at the time of this report, 33 were available for follow-up with a follow-up period ranging from 2 to 20 mo and averaging 10 mo. At the time of follow-up, 22 patients were in satisfactory condition, as judged by urethrography and urethroscopy. Nine patients had required reoperation. Expert’s opinion: The other important paper is from John Swinnney [2]. He used almost the same technique as Johanson’s and started at about the same time, but his paper is 0302-2838/$ – see back matter
doi: 10.1016/j.eururo.2007.01.054
less well-known. Their techniques—in fact—are almost irrelevant. The point of their publications is that they represent the first consistent attempt to try and treat urethral strictures curatively if the patient would otherwise need frequent and lifelong dilatation or urethrotomy. Nowadays, with better urologic care and the routine use of antibiotics, it is easy to underestimate the misery that many patients endured in the past, from a lifetime of dilatation of their urethral strictures and with the common need for frequent instrumentation, often accompanied by bleeding and sepsis. The efforts of Swinney and Johanson, developed from the Dennis Browne principle, and developed by others, notably Ledbetter [3] and Turner-Warwick, put an end to all this [4]. The Duplay-Dennis Browne-Johanson-Swinney procedure is rarely used now as a matter of choice, but as a result of these surgeons’ pioneering efforts the problems of stricture patients are now amenable to cure when instrumentation is only palliative and when a lifetime of instrumentation might be their only alternative.
References [1] Browne D. An operation for hypospadias. Lancet 1936;i: 141–3. [2] Swinnney J. Urethroplasty: an assessment after seven years experience. Br J Urol 1957;29:293–7. [3] Ledbetter GW. A simplified urethroplasty for strictures of the bulbous urethra. J Urol 1960;83:54–9. [4] Turner-Warwick RT. A technique for posterior urethroplasty. Urol 1960;83:416–21.
A.R. Mundy Institute of Urology, London, UK DOI:10.1016/j.eururo.2007.01.055