Introduction: We explored the historical origins of and developments in dilation and urethrotomy for the treatment of urethral stricture disease (USD).

Methods: Primary and secondary source documents relating to USD were reviewed and put into perspective within current practices.

Results: The earliest known treatment for USD is from the Ayurveda, when in 600 BC, Sushruta of India used metal and wooden dilators lubricated with ghee. By 200 BC, Erasistratus of Greece had developed S-shaped metal catheters. This was adapted and modernized by the Romans, who used lead and bronze dilators. It was not until the first recorded epidemic of gonorrhea in 1520 AD that a renewed focus on USD arose and a primitive form of internal urethrotomy was developed. By 1730 AD, Ledran of France performed the first recorded successful external urethrotomy, lending credence to the role of diversion in USD. Near the end of the 1700s AD, Desault of France first described using a fine guide with a larger following instrument. The development of the lancellated catheter in 1795 AD successfully allowed for internal urethrotomy and paved the future for the development of later internal urethrotomes. It was only in 1996 AD when Freid and Smith of America described using a guidewire to cannulate the urethra and then dilate overtop using a Seldinger technique. In 1997 AD, Steenkamp, Heyns, and de Kock of South Africa published a landmark trial demonstrating equivalent outcomes between filiform dilation and direct visual internal urethrotomy. Ten years later, Herschorn of Canada introduced S-shaped coaxial urethral dilators, and four years after that, Gelman, Liss, and Cinman of America described direct vision balloon dilation. More recently, drug-coated balloon dilation is being investigated.

Conclusions: The origins of endoluminal treatment of USD can be traced back to nearly twenty-six centuries ago. Current guidelines rely on limited and dated evidence. We demonstrate that this field is ripe for further advancements.