Dorsal Onlay Oral Mucosa (DOOM) urethroplasty for post-hypospadias stricture.

American Society for Gastrointestinal Endoscopy Technology Status Evaluation Report: tools for benign pancreaticobiliary dilation.

Anastomotic stricture (AS) is a common late complication after esophagectomy. Evidence guiding endoscopic escalation ("step-up") and the risk of post-treatment recurrence remains limited. We assessed clinical, surgical, and procedural determinants of (i) need for step-up therapy and (ii) recurrence after initial endoscopic success. We conducted a multicenter retrospective study at two tertiary centers in Milan (2014-2024). Adults with naïve post-esophagectomy AS underwent standardized endoscopic management (bougie or pneumatic dilatation with predefined step-up options: incision therapy, stenting, steroid injection). Outcomes included technical (TS) and clinical success (CS), safety, rates of step-up and recurrence, and uni/multivariable predictors of change of strategy and recurrence. Among 1729 esophagectomies, 61 patients (3.5%) developed benign AS. Initial therapy was bougie in 54.1% and pneumatic in 45.9%. TS was achieved in 100% and CS in 93.4%. Safety was favorable (1/61, 1.6%). Overall, 39.3% required a change of strategy, typically early: the first switch occurred at a median of 35days, and in 62.5% within 30days, most often for failure to achieve a ≥ 2-mm lumen gain (66.7%). On multivariable analysis, higher BMI (OR 0.81 per 1kg/m2, p = 0.022) and baseline dysphagia < 2 (OR 0.13, p = 0.006) independently reduced the likelihood of step-up. Among patients with CS, recurrence occurred in 24.6% (14/57). In models restricted to surgical variables, stapled versus hand-sewn anastomosis was protective (OR 0.11, p = 0.022), whereas procedure type (McKeown vs Ivor-Lewis) and caliber ≤ 25mm were not significant. Endoscopic treatment of post-esophagectomy AS is highly effective and safe, yet step-up intervention is required in nearly 40% and recurrence occurs in one quarter of patients. Nutritional status and baseline dysphagia help identify patients at higher risk of escalation, while stapled anastomoses appear to reduce recurrence. These findings support a risk-adapted, personalized endoscopic strategy and warrant prospective validation.

A 3-year-old neutered male domestic shorthair cat was evaluated for hematuria. Ultrasonography and CT scanning identified moderate right-side hydronephrosis associated with right proximal and distal ureteral strictures, as well as partial stenosis of the left distal ureter. Medical management, including fluid therapy, ureteral muscle relaxants, and corticosteroids, was initiated but failed to improve progressive renal pelvic dilation as assessed on serial ultrasound scans. This case highlights the limited efficacy of conservative therapy and contributes to the growing body of evidence on the management of feline ureteral strictures.

Urethroplasty is the gold standard for urethral stricture but is limited by technical complexity and surgeon expertise. Thus, urethrotomy and dilatation remain common despite high recurrence rates (40-60%) from fibrosis. Platelet-rich plasma (PRP), a regenerative therapy, promotes tissue healing but contains transforming growth factor-β1 (TGF-β1), which may worsen fibrosis. To overcome this, a modified PRP (mPRP) was developed by neutralizing TGF-β1, aiming to enhance healing while reducing fibrosis and recurrence in urethral stricture management. An experimental study was conducted using New Zealand White rabbits (Oryctolagus cuniculus). A urethral stricture model was induced through surgical urethral injury followed by TGF-β injection. Animals were treated with either standard PRP or mPRP. Outcomes were assessed through immunohistochemistry (IHC) and retrograde urethrography. Collagen thickness decreased in the PRP group (16.2 ± 2.4µm; p < 0.05) and further in the mPRP group (11.38 ± 1.46µm; p < 0.05). IHC revealed lower collagen type III levels in the mPRP group (3.0 ± 1.0) compared with PRP (6.8 ± 0.83), yielding a higher collagen I:III ratio (1:2.6 vs. 1:1.36). Urethrography demonstrated a wider lumen (2.72 ± 0.14mm) and shorter stricture length (0.60 ± 0.63cm) in the mPRP group compared to PRP (2.41 ± 0.10mm and 2.48 ± 0.16cm; p < 0.05). mPRP effectively reduces fibrosis and inhibits stricture recurrence, as evidenced by decreased collagen expression and improved urethral lumen dimensions, supporting its potential as an adjunctive therapy for urethral stricture management.

Background: Management of urethral stricture remains a challenging aspect of reconstructive urology. Repeated surgical interventions may increase the risk of complications, including urinary incontinence. Therefore, conservative adjunct strategies such as clean intermittent catheterization (CIC) following direct visual internal urethrotomy (DVIU) have been proposed to improve outcomes. This study aimed to evaluate and compare the outcomes of DVIU followed by CIC versus DVIU alone in patients with symptomatic urethral stricture. Methods: A total of 92 patients diagnosed with symptomatic urethral stricture were enrolled and randomly assigned into two groups: DVIU with CIC and DVIU without CIC. Patients were followed for 12 months. Outcomes were assessed using the Urethral Stricture Surgery Patient-Reported Outcome Measure (USS-PROM) through direct clinical interviews. Primary outcomes included the rate of urinary tract infection (UTI), need for subsequent surgical intervention, and quality of life. Results: Of the participants, 46 (47.9%) underwent DVIU with CIC and 50 (52.1%) underwent DVIU without CIC. The need for further surgical intervention was significantly lower in the CIC Group (4 patients) compared to the non-CIC Group (30 patients). Although urinary tract infection rates were higher in the CIC Group, overall patient-reported outcomes were significantly better. The mean Peeling’s voiding picture score (Q8) and EQ-VAS score (Q16) were significantly improved in the CIC Group (p = 0.02). Conclusion: Post-DVIU clean intermittent catheterization is a safe, simple, and well-tolerated home- based intervention that significantly reduces the need for repeat surgical procedures and improves patient-reported outcomes, despite a higher incidence of UTI. It represents an effective adjunctive strategy in the management of urethral stricture.

Drug-coated balloon (DCB) urethral dilatation which offers an alternative to standard endoscopic treatments of male anterior urethral stricture disease (AUSD). Its ease of delivery has facilitated its use by urologists with various subspecialty interests. The objective of this study was to characterise real-world practice patterns of a DCB device. An exploratory cross-sectional online survey was distributed to Optilume® users via national and international urological societies and device distributor mailing lists. Descriptive and inferential statistics were performed using SPSS software. N = 102 urologists responded to the survey of whom n = 47 (46%) were reconstructive subspecialists. DCB dilatation was predominantly performed under general anaesthesia (n = 59, 58%). Significant variation was seen with catheter duration, perioperative antibiotic use and post-procedure contraception advice. Off-label use was common with respondents offering DCB for penile urethral strictures (65%), primary treatment (64%) and bladder neck stenoses (65%). Higher-volume users (≥ 10/year) were more likely to perform DCB under flexible cystoscopy (OR 5.14, 95% 1.57-16.79, p = 0.007), bladder neck stricture (OR 4.66, 95% CI 1.55-14.03, p = 0.006), and for recurrences (OR 6.92, 95% CI 2.22-21.6, p = 0.001). Limited practitioner experience, an evidence gap, and the importance of shared decision making were highlighted on thematic analysis. This study provides an insight into the early experience a novel DCB among practicing urologists. Further research is required to optimize patient selection, procedural protocols and the understanding of long-term outcomes.

Which benign-appearing impassable sigmoid strictures are safe to manage conservatively? Insights from a multicenter cohort.

AB019. SOH26AB_0428. Endourologic versus surgical management of ureteric stricture after kidney transplantation: a systematic review and meta-analysis

The management of urethral strictures in Ukraine has gained particular importance due to the increasing number of combat-related injuries caused by the armed aggression of the russian federation. Minimally invasive treatment methods, including urethral dilation and internal optical urethrotomy (IOU), are associated with high recurrence rates, while current clinical guidelines expand the indications for urethroplasty. The objective: analysis of the experience of three medical centers in evaluating the effectiveness of urethroplasty. Materials and methods. A retrospective analysis was conducted of 106 patients with urethral strictures and distraction defects who underwent urethroplasty in the urology departments of three institutions over a period of 3.5 years. The mean age was 44.1 ± 12.7 years. Uroflowmetry was performed in 36% of patients, retrograde urethrography in 90%, and cystourethroscopy in 48%. In 50% of cases, strictures were of traumatic origin, in 23% idiopathic, and in 16% iatrogenic. The mean stricture length was 2.8 ± 3.0 cm. Most patients underwent augmentation urethroplasty using a buccal graft (59%) or anastomotic urethroplasty (34%). Surgical success was defined as the absence of the need for additional interventions. Outcomes were objectively assessed using the Patient-Reported Outcome Measure for Urethral Stricture Surgery questionnaire. Results. A satisfactory outcome without the need for repeat surgical correction was achieved in 85% of patients. IOU was required in 7 cases, repeat urethral reconstruction in 8 patients, periodic self-dilation was performed in 1 case, and 1 patient was considered unsuitable for reconstruction. Complications occurred more frequently in complex, post-traumatic, or recurrent strictures and were observed in 39% of cases. Conclusions. The analysis confirms the effectiveness of urethroplasty and demonstrates consistency of the obtained results with data reported in specialized literature. A distinctive feature of the cohort is the high proportion of complex post-traumatic strictures associated with combat injuries.

Benign biliary strictures are an uncommon but significant complication following hepatobiliary surgeries, most often seen after cholecystectomy or biliary-enteric anastomosis. While Roux-en-Y hepaticojejunostomy is the standard surgical treatment for high bile duct strictures, recurrence of the stricture remains a complex problem, especially when the anatomy is distorted by fibrosis or previous surgery or when it presents as cholangitis episodes very late after surgery. Revision surgery in these cases is challenging, and timely recognition and resource-appropriate interventions are key to optimal outcomes. We describe a case series of seven patients who underwent revision surgery for recurrent benign biliary strictures following Roux-en-Y hepaticojejunostomy. Three patients were found to have high-level strictures (Strasberg E4) at the time of revision surgery. While most patients were managed with standard surgical techniques, in one of these patients, dense adhesions and scarring made ductal identification nearly impossible, where intraoperative ultrasound-guided biliary catheter placement was used as a salvage technique to localize the biliary ducts transhepatically, creating a neo-hepaticojejunostomy. All patients had a satisfactory recovery, with resolution of jaundice and normalization of liver function over a follow-up period of one year. Revision surgery for recurrent benign biliary strictures after Roux-en-Y hepaticojejunostomy remains technically demanding due to altered anatomy and fibrosis, where it becomes difficult to differentiate structures. Careful preoperative planning, meticulous intraoperative dissection, flexible surgical strategies, and multidisciplinary cooperation and planning are essential for successful reconstruction and favorable outcomes.

Primary sclerosing cholangitis (PSC) is a progressive fibroinflammatory disease characterized by multifocal biliary strictures, recurrent cholangitis, and a markedly increased lifetime risk of cholangiocarcinoma (CCA). Endoscopic retrograde cholangiopancreatography (ERCP) remains central to the diagnosis of CCA and management of PSC-related complications. This review synthesizes current evidence guiding the use of ERCP in patients with PSC, highlighting the importance of careful patient selection to mitigate adverse events. We review traditional ERCP techniques for the evaluation of dominant strictures such as brush cytology, fluorescence in situ hybridization (FISH), and biopsies, which exhibit limited sensitivity for detecting CCA in PSC. We also review the role of advanced endoscopic approaches including cholangioscopy, endoscopic ultrasound, and confocal endomicroscopy, alongside novel molecular diagnostics (next generation sequencing, DNA methylation markers), metabolomics, bile microbiome, and radiomics, which shown promise for risk stratification and CCA detection in PSC. Therapeutically, we review evidence supporting the use of balloon dilation as first line therapy for the management of PSC strictures and discuss settings where plastic stents might be beneficial. Furthermore, we review the endoscopic management of other PSC complications such as cholangitis, stones, acute cholecystitis, and post-transplant strictures. Finally, we provide best practice recommendations to minimize risk of complications, including use of peri-procedural antibiotic prophylaxis, technique modifications, and individualized sphincterotomy decisions. As innovative diagnostic and therapeutic strategies for PSC continue to evolve, rigorous multicenter, prospective studies are needed to assess efficacy, safety, and cost-effectiveness of these strategies prior to widespread adoption.

Esophageal anastomotic stricture is a common complication following esophageal atresia (EA) repair. While multiple endoscopic therapies exist, predicting individual stricture response remains challenging. Existing classification systems focus primarily on luminal diameter and do not account for complex physical characteristics of the stricture. We developed and evaluated a novel endoscopic scoring tool, stricture classification of pediatric esophageal strictures (SCOPES), to determine if physical features are predictive of treatment response. In addition to its predictive utility, SCOPES aims to standardize the description of and improve communication of stricture morphology across providers and institutions. A retrospective cohort study was conducted on EA patients treated at a tertiary referral center between 2019 and 2024. Patients with ≥2 endoscopies and documented SCOPES scores were included. The SCOPES tool categorizes strictures based on diameter, length, scar band intrusion, symmetry, and presence of diverticula. Multivariable mixed-effects regression models were used to analyze associations between SCOPES characteristics and the primary outcome of number of therapeutic endoscopies within 6 months. Seventy patients (238 endoscopies) met inclusion criteria. In multivariable analysis, symmetric strictures and those with highly intrusive scar bands were significantly associated with a greater number of therapeutic endoscopies within 6 months. Two complications were observed, both managed without long-term sequelae. The SCOPES classification tool identifies physical stricture features that significantly influence response to endoscopic therapy. Circumferential symmetry and scar tissue protuberance were associated with higher treatment burden, suggesting these characteristics may guide therapeutic decision-making. SCOPES may aid in individualizing endoscopic management of pediatric esophageal strictures and warrants prospective validation.

Revisiting fundoplication in esophageal atresia: implications for nutrition, stricture management, and wrap type.

Biliary strictures (BS) remain a common and serious complication after pediatric liver transplantation (pLT), potentially leading to recurrent cholangitis and graft failure. Prompt diagnosis and appropriate management are essential to improve outcomes. This retrospective, single-center study included 1454 pediatric liver transplants performed between January 2013 and December 2021. BS were classified as anastomotic strictures (AS), non-anastomotic strictures (NAS), or intraoperative technical misadventure (ITM). Cases involving both AS and NAS were classified under the BOTH group. A standardized percutaneous transhepatic cholangiography drainage (PTCD)-based protocol was applied: mild strictures were treated with PTCD alone, whereas severe strictures required balloon dilatation (BD) with external drainage. Surgical revision was performed when guidewire passage failed. Outcomes included stricture resolution, recurrence, and graft survival. BS occurred in 120 patients, with AS accounting for 63.3%, NAS & BOTH for 31.7%, and ITM for 5.0%. The overall incidence of BS declined significantly from 12.38% (2013-2016) to 7.07% (2017-2021). PTCD ± BD achieved an 85.7% resolution rate in AS, while surgical reanastomosis was successful in all refractory cases. NAS & BOTH were associated with significantly lower graft survival and showed limited response to both minimally invasive and surgical treatments. Minimally invasive approaches, particularly PTCD ± BD, combined with timely surgical intervention, is effective for AS after pLT. However, NAS & BOTH remain challenging and are associated with inferior graft outcomes, underscoring the need for improved early detection and the development of novel therapeutic strategies.

Postoperative benign bilioenteric anastomotic stricture (BBAS) is a serious complication of biliary surgeries. To determine the efficacy and safety of percutaneous transhepatic cholangioscopy (PTCS)-assisted procedures, including stricture dilation and recanalization for BBAS and biliary stone therapy for concomitant stones. Patients with BBAS who received PTCS-assisted procedures were included. Primary outcomes were anastomotic patency (including initial anastomotic patency after stricture dilation and cumulative anastomotic patency after PTCS catheter removal) and treatment success (i.e., negative clinical clamping trial and removable indwelling PTCS catheter). Secondary outcomes were technical success for the three PTCS-assisted procedures, duration of the indwelling PTCS catheter, and adverse events. Forty patients were included; 32 underwent PTCS-assisted stricture dilation/recanalization and 36 underwent biliary stone therapy. The initial patency rates were 58.1% and 41.9% at 1 and 2 years, respectively, and the cumulative patency rates were 74.3%, 59.7, 49.8%, and 34.8% at 1, 3, 5, and 7 years, respectively. The treatment success rate was 90.6% (29/32) for PTCS-assisted stricture procedures. The technical success rates were 100% (31/31), 87.5% (7/8), and 94.5% (34/36) for PTCS-assisted stricture dilation, recanalization, and biliary stone therapy, respectively. The median duration of the indwelling PTCS catheter in the 29 patients with treatment success was 6 (range: 2-109) months. Only one patient experienced acute bleeding, which was manageable. PTCS-assisted procedures are efficacious and safe for the management of BBAS and concomitant biliary stones. Placement of an indwelling PTCS catheter across the anastomosis after stricture dilation improves the anastomotic patency.

Endoscopic stricture management has revolutionized the care of inflammatory bowel disease (IBD), particularly Crohn's disease (CD), offering minimally invasive options to delay or replace surgery. Endoscopic balloon dilation (EBD), endoscopic stricturotomy (ES) and self-expanding metal stents (SEMS) are the mainstays for fibrotic or mixed strictures. Hybrid techniques such as combining EBD/SEMS and ES or adjunctive use of novel drug-coated balloons are evolving approaches. However, recurrence remains a major challenge with EBD, with up to two-thirds of patients requiring re-intervention. ES has higher long-term efficacy than EBD. Fully covered and partially covered self-expanding metal stents (SEMS) may be useful in long and refractory strictures whereas lumen-apposing metal stents (LAMS) can be used in short and anastomotic strictures. This manuscript reviews the present modalities, their outcomes and promising future advancements in endoscopic stricture management in CD. Interventional IBD (IIBD) plays a key role in the multi-disciplinary management of complex IBD acting as a bridge between medical and surgical therapy for properly selected IBD patients.

Endoscopic balloon dilation versus stent placement in the management of dominant strictures in primary sclerosing cholangitis: a systematic review and meta-analysis.

Topical mitomycin C application versus intralesional corticosteroid injection in the management of caustic esophageal strictures in pediatrics: A randomized controlled trial.

P0249 Endoscopic management of iatrogenic ureteral strictures: Risk factors for treatment failure