ABSTRACT
Historically, the reconstructive ladder approach to urethral stricture disease has long been held. This consists of performing the simplest operation first, and, if this step fails, repeating it or progressing to the next most complex procedure. The root of this method can be traced back to R Hamilton Russell who stated in the British Journal of Surgery in 1914:1
Excision of the stricture has never been very generally practiced, and is only attempted in only a small minority of cases: the reason is that the operation . . . is difficult and uncertain in its results . . . This is so well recognized by surgeons of experience in this class of work, that they urge great pains should be taken to obviate the perineal open operation.
