Sachse Optical Urethrotome in Management of Urethral Stricture in the Male: Preliminary Communication

Abstract

Stricture of the male urethra is traditionally treated by regular dilatation or urethroplasty. Urethrotomy, the third method of dealing with stricture, has interesting historical associations (M urphy 1972) and though not used extensively in the past, when properly applied it has produced good results (Helmstein 1964). However, it is a blind procedure and even when urethroscopy is used before and after the incision (Helmstein 1964) it still remains a somewhat cumbersome technique. The development of an optical urethrotome has, however, altered this situation. The first optical urethrotome used electrocautery to incise the stricture (Ravasini 1957), but more recently Sachse (1974) has developed an optical urethrotome with a fine scalpel.This paper is a preliminary communication on our initial experience with the Sachse optical urethrotome. Instrument and techniqueThe instrument (as supplied by Storz Limited) consists of a standard pan endoscope using either a 30°or 0°viewing lens. The scalpel is similar to that used in neurosurgery and consists of an anterior and superior cutting edge ( Figure I). It is mounted on two carrying rods and inserts into a Nesbitt action electrotome. The instrument is inserted into the urethra and the stricture visualized (Figure 2). Through a side arm, a small ureteric catheter may be passed through the stricture in order to provide evidence of the direction of the urethra, both through and beyond the stricture. The knife is now extended beyond the pan endoscope sheath and the fibres of the stricture are then divided by an upward cutting movement of the blade (Figure 3). The whole instrument is used and the cutting is continued until all the fibres of the stricture are divided. It is quite easy to identify these fibres of the stricture and with the cutting action they can be seen to spring apart. Sometimes the incision needs to be carried deep into the wall of the urethra and bleeding may be encountered. In this case the ureteric catheter can be removed, a diathermy electrode passed down the side arm and any-bleeding points cauterized. After full incision of the stricture has been performed, the rest of the urethra, prostate, bladder neck and bladder can be inspected. Following the incision of the stricture a fenestrated catheter may be left in place for a period varying from one to seven days. The fenestrations in the catheter enable blood to drain away from the site of the incision. The technique, though simple does require a full understanding of endoscopy.I Paper read to Section of Urology,

Long‐term Results of Optical Wrethrotomy

“…Sachse (1974) developed the first urethrotome, using a fine movable scalpel to incise urethral strictures under direct vision. The first optical urethrotomy performed in the United Kingdom was in the Avon area in 1975, Smith et al (1978 reporting in a preliminary communication their satisfactory initial experience with the Sachse optical urethrotome. Since then the use of optical urethrotomy has spread rapidly and it has now become the initial treatment of most strictures of the male urethra by the majority of urologists (Smith et al, 1981 ;Sachse, 1982).…”

Is anastomotic urethroplasty is really superior than BMG augmented dorsal onlay urethroplasty in terms of outcomes and patient satisfaction: Our 4-year experience

“…2 In addition, Sachse (1974) revolutionized the treatment by optical urethrotomy. 3 Devine and colleagues (1980) in their guest editorial recommended treating partial urethral stricture by dilatation first and, if not relieved, then by visual cold knife internal urethrotomy. 4 Gonococcal urethral stricture is rare in this era of broad spectrum antibiotics, but infection remains a major cause, particularly from long-term use of an indwelling urethral catheter.…”

Evaluation of holmium laser versus cold knife in optical internal urethrotomy for the management of short segment urethral stricture

“…[10] Optical internal urethrotomy has the advantage of ease, simplicity, speed, and short convalescence. In 1957, Ravasini[11] described internal urethrotomy under direct vision and used electrocautery to incise the stricture, but it was not until 1971 that Sachse[12] introduced the sharp-bladed cold-knife urethrotome under direct vision, reporting 80% success rate with this procedure in 1974.…”