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.

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

A0813 Outcomes of female urethral stricture management: Augmentation urethroplasty versus incision urethrotomy – results from a randomized controlled trial

Despite well-defined standards for urethral stricture management, significant practice variations persist. This survey assessed guideline adherence among Turkish urologists. An online SurveyMonkey survey was sent to Turkish Urological Association members, open October 10-17, 2021, with two reminders. Data were centrally collected and analyzed using descriptive statistics. Of 2,078 members, 222 (11%) responded, mostly aged 30-45 years. Retrograde urethrography (26%), uroflowmetry (90%), and cystourethroscopy (61%) were used for diagnosis, with academic urologists employing these more often (p < 0.05). Blind dilatation with metal bougies (47%) exceeded plastic dilators over guidewire (23%) or disposable catheters (26%). Material preference was unrelated to experience (p = 0.39), but non-metal methods were more common in academic centers (p = 0.04). For 1-2cm primary bulbar strictures, 7% chose urethroplasty, while 72% preferred Direct Vision Internal Urethrotomy (DVIU) with dilatation. Academic urologists performed more urethroplasties (p = 0.01). In recurrent cases, 76.5% performed DVIU ≥ 4 times, and 79.3% recommended periodic post-DVIU dilatation. Urologists' approaches to urethral strictures often deviate from guidelines. Retrograde urethrography use is low, metal bougies dominate dilatation, and urethroplasty is underused, favoring repeated DVIU and dilatation. Academic urologists adhere more to guideline recommendations than non-academic peers.

Urethral stricture disease poses a significant reconstructive challenge, particularly in patients with long-segment strictures or those associated with lichen sclerosus. Staged urethroplasty remains a reliable and well-established approach in such complex cases. This case series evaluates the outcomes of Johanson's Stage II urethroplasty using inlay buccal mucosal grafts performed at a tertiary care centre. A retrospective review was conducted of patients who underwent Stage II urethroplasty following prior Stage I reconstruction. Preoperative assessment included uroflowmetry and retrograde urethrography, and an inlay buccal mucosal graft was used in selected cases requiring urethral augmentation. Patients were followed to assess functional outcomes and postoperative complications. Successful voiding was achieved in 90% of patients, with postoperative maximum urinary flow rates exceeding 15 mL/s. Two patients developed minor postoperative complications, which were managed conservatively. Cosmetic outcomes and sexual function were satisfactory in the majority of patients. Staged urethroplasty with buccal mucosal graft augmentation remains a gold-standard technique for the management of complex urethral strictures, offering excellent functional outcomes and durable results.

Radiation-induced colorectal strictures represent a challenging late complication of pelvic malignancy treatment, often accompanied by extensive fibrosis and multi-organ involvement. We report the case of a 55-year-old female with a history of cervical cancer treated with pelvic radiation, complicated by radiation proctitis, diverticular disease, pelvic adhesions, and bilateral ureteral obstruction, who underwent a single-stage multidisciplinary surgical reconstruction. The procedure included colostomy takedown, rectosigmoid resection with coloanal anastomosis, pelvic abscess debridement, diverting loop ileostomy creation, total abdominal hysterectomy, ileoureteral conduit formation, and ventral hernia repair with myocutaneous flap closure. The postoperative course was complicated by a high-output ileostomy resulting in electrolyte derangements, acute kidney injury, and malnutrition, requiring coordinated medical management with antidiarrheal therapy, electrolyte repletion, and nutritional support. This case underscores the complexity of late radiation sequelae and highlights the importance of multidisciplinary collaboration in achieving successful surgical and medical outcomes.

Abstract Pancreatic and biliary tract injuries from blunt abdominal trauma are rare in children. Common bile duct (CBD) strictures secondary to pancreatic trauma are even more uncommon, and management traditionally involves surgery. We report a 9‐year‐old boy who developed a severe distal intrapancreatic CBD stricture after blunt pancreatic trauma during an all‐terrain vehicle (ATV) accident. Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) demonstrated a 25 mm stricture in the lower CBD. The stricture resolved after two sessions of ERCP with biliary stenting, avoiding surgery. This case highlights a rare but significant delayed biliary complication of pediatric blunt pancreatic trauma. Early recognition and minimally invasive endoscopic intervention can achieve successful stricture resolution and may prevent the need for surgical repair. This case adds to the scarce literature on pediatric traumatic pancreatitis–associated distal CBD stricture managed successfully with ERCP and stenting.

Bariatric surgery is an effective treatment for morbid obesity but is frequently complicated by anastomotic leaks, fistulas, and strictures, which can significantly impair patient outcomes. Optimal management of these complications relies on a timely and accurate diagnostic assessment; however, effective treatment strategies are central to improving clinical recovery. This review primarily focuses on the endoscopic management of post-bariatric surgery complications, while providing a concise overview of the diagnostic imaging modalities that guide therapeutic decision-making. Contrast-enhanced imaging techniques, including computed tomography (CT) and fluoroscopy, as well as endoscopic ultrasound (EUS), are briefly discussed in relation to their role in identifying complications, defining their extent, and selecting the most appropriate endoscopic intervention. The core of this review is dedicated to current endoscopic treatment approaches, including endoscopic internal drainage with double pigtail plastic stents, self-expanding metal stents (SEMSs), endoscopic vacuum therapy (EVT), and EUS-guided drainage of fluid collections. Particular emphasis is placed on indications, technical considerations, and outcomes of these therapies. Finally, this review highlights emerging endoscopic technologies that may further optimize the management of post-bariatric surgery complications and improve patient outcomes, underscoring the evolving role of minimally invasive endoscopic treatment within a multidisciplinary framework.

Graphene oxide nanoscaffold functionalized with adipose-derived mesenchymal stem cells and sildenafil promotes urethral stricture repair and tissue regeneration.

Chronic double-J stenting or nephrostomy dependence remains the default management for radiation-induced ureteral strictures (RIUS). This study aimed to evaluate the feasibility and clinical efficacy of robotic ileal ureter replacement (IUR) in managing RIUS with prior pelvic malignancy radiotherapy. In our prospective multi-institutional RECUTTER database, 35 patients with a diagnosis of RIUS underwent robotic IUR between March 2019 and April 2024. Unilateral and bilateral procedures were performed with or without augmentation ileocystoplasty. Baseline characteristics, perioperative, and follow-up results of the patients were collected. Postoperative complications were evaluated using the Clavien-Dindo (CD) Classification system. All patients were female with a mean age of 49.46±8.25 year. Cervical carcinoma was the predominant primary malignancy for radiotherapy (85.7%). The median length of the ileal graft was 28 cm (range 15-45). The mean operative time was 331.6±112.3 min, and the median estimated blood loss was 50 mL (range 20-100). The mean postoperative hospitalization was 12.43±6.00 day. During the median follow-up of 20 months (range 12-74), 34 patients (97.1%) achieved clinical success. One case of surgical failure developed right ureteral restenosis post-bilateral IUR. Complications included short-term (20%: CD grade I 11.4%, grade II 8.6%) and long-term events (22.9%, all grade II). No grade ≥III complications occurred. Robotic IUR represents a feasible and effective option-for managing RIUS after pelvic malignancy radiotherapy, addressing surgical challenges posed by dense adhesions, retroperitoneal fibrosis, extensive bilateral strictures, and concurrent bladder contracture.

IntroductionUreteral injuries during gynecologic surgery are uncommon (0.1%–2.5%) but may result in significant morbidity, including strictures, hydronephrosis and the need for additional interventions. This study evaluates the effectiveness of retrograde endoscopic management in treating iatrogenic ureteral injuries.Materials and MethodsA retrospective review was conducted on women diagnosed with ureteral injury post‐gynecologic surgery between 2010 and 2024 at a single institution. Patients were categorized into two groups: those treated with retrograde endoscopic interventions and those managed with non‐endoscopic approaches (percutaneous nephrostomy and/or surgical reconstruction). The endoscopic group was further divided into early (<3 months post‐injury) and late interventions. Outcomes assessed at ≥3 months of follow‐up included treatment success, long‐term complications and the need for further interventions.ResultsOf 42 patients, 29 (69%) underwent endoscopic treatment and 13 (31%) received non‐endoscopic management. Among endoscopically treated patients, early intervention achieved an 80% success rate, significantly higher than the 33% observed with late intervention (p = 0.03). All non‐endoscopic patients initially received percutaneous nephrostomy, and 12 (92.3%) required definitive surgical repair. Endoscopic treatment was associated with reduced operative time and shorter hospital stays. Given the rarity of ureteral injuries, the cohort represents one of the largest single‐centre experiences focused on this specific population.ConclusionsEarly retrograde endoscopic management is a safe and effective approach for treating ureteral injuries after gynecologic surgery. Timely diagnosis and intervention significantly improve outcomes. Non‐endoscopic patients were more complex cases, often unsuitable for endoscopy, which may account for outcome differences. Intraoperative retrograde ureterography and stenting should be considered whenever there is suspicion of ureteric injury, whereas postoperative endoscopic realignment or endoscopic management of ureteric strictures should be performed by appropriately trained urologists. Further prospective studies with larger cohorts and longer follow‐up are warranted to refine optimal clinical pathways and long‐term management strategies.

Rationale:Urethral stricture is the scarring and healing of the urethral epithelium or the corpus spongiosum layer just beneath it, following damage to the urethra for any reason. The curative and the gold-standard treatment is urethroplasty. The management of posterior urethral strictures is 1 of the most difficult problems for urologists and requires special attention and reconstructive experience.Patient concerns:A 79-year-old male who developed osteomyelitis following posterior urethroplasty.Diagnoses:Osteomyelitis was diagnosed after magnetic resonance imaging and bone biopsy. Histopathological examination confirmed osteomyelitis, and tissue cultures grew Escherichia coli and Klebsiella species.Interventions:The patient was initiated on intravenous meropenem therapy. Based on recommendations from clinical microbiology and infectious diseases specialists, a prolonged 6-week antibiotic regimen was administered.Outcomes:After parenteral antibiotic treatment, the patient’s clinical and laboratory parameters returned to normal.Lessons:To the best of our knowledge, this complication has not been previously described, making our case the first reported and, therefore, unique.

{"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_76493li1"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} CASE REPORT Spray cryotherapy uses liquid nitrogen to freeze and destroy tissue and is used for esophageal cancer and Barrett esophagus.1–3 Its use for benign strictures is mostly only reported in small case reports or series.4,5 Because liquid nitrogen expands up to 700 times as it evaporates, a venting tube must be placed to remove gas to prevent excessive intraluminal pressure.3 Limited data exist in its safety and efficacy in patients without a stomach to accommodate gaseous distension. We present a unique case of a successful spray cryotherapy-assisted dilation for refractory esophagojejunal stricture. A 70-year-old woman with total gastrectomy and esophagojejunal anastomosis presented with severe dysphagia from an anastomotic stricture (Figure 1) requiring nasojejunal tube feeds. An adult gastroscope was never able to traverse through despite 5 prior dilations with steroids. An ultrathin gastroscope traversed stricture to place a ventilation tube in jejunum. Liquid nitrogen cryogen was then applied for 20 seconds with frosting effect for 2 cycles (Figure 2). The stricture was dilated gradually in a stepwise fashion to 15 mm (Figure 3), with tissue disruption and improved luminal patency (Figure 4). Throughout the procedure, the patient's abdomen was closely monitored for distension. The patient tolerated the procedure well and was able to remove feeding tube. She underwent multiple cryodilation sessions safely and is now tolerating a regular diet.Figure 1.: Severe esophagojejunal stricture, initially with moderate resistance with passage of an adult gastroscope.Figure 2.: Frosting effect of the spray cryotherapy on the target area.Figure 3.: Through-the-scope balloon dilation.Figure 4.: Moderate mucosal disruption after spray cryotherapy with dilation.To our knowledge, this is the first to report spray cryotherapy for management of esophagojejunal anastomotic stricture in a patient with gastrectomy. In patients with an intact stomach, the stomach serves as a large, compliant reservoir capable of accommodating abrupt increases in intraluminal pressure and volume as the liquid nitrogen evaporates into gas. Without a stomach to assist with this rapid volume expansion, spray cryotherapy could be potentially more challenging. Thus, this case emphasizes the importance of continuous abdominal assessment during the spray cryotherapy procedure. Furthermore, this case illustrates that spray cryotherapy is safe and effective in patients with altered anatomy that may limit gastrointestinal luminal compliance. DISCLOSURES Author contributions: GE Kim literature review, performed the procedure, drafted abstract. UD Siddiqui revised and finalized the abstract and is the article guarantor. Financial disclosure: GE Kim—none. UD Siddiqui—consultant, speaker, research support: Olympus, Boston Scientific; consultant, speaker: Cook, ConMed, Medtronic. Informed consent was obtained for this case report.

Urethral stricture is a common urological disease characterized by a narrowing of the urethra leading to functional changes that reduce or completely block urine flow from the kidney to the bladder. This condition significantly affects the patient's quality of life and can lead to serious complications, such as urethral dilatation and hydronephrosis, which may result in irreversible kidney failure if left untreated. This was an observational cross-sectional study conducted on 35 patients, treated for urethral stricture at the Department of Uro-nephrology Surgery, Ninh Thuan Province General Hospital, from January to October 2023. All enrolled patients underwent urethral stricture endoscopic incision using holmium laser, and were followed up at 1 and 3 months postoperatively. The difference in the degree of hydronephrosis on CT scans before and after surgery at 3 months was statistically significant (p < 0.01). To report the safety and efficacy outcomes of holmium laser urethrotomy for the treatment of urethral stricture, patients underwent internal urethrotomy with holmium laser energy, with an average age of 47.7 ± 15.8 years (range: 15-72 years). Thirty patients (85.7%) underwent urological surgery, 3 (8.6%) underwent obstetric and gynecological surgery, and 2 (5.7%) had unknown etiologic causes. The use of the holmium laser for the management of urethral strictures has been found to be safe and effective, ensuring shorter operating times, a lower recurrence rate, and fewer serious postoperative complications.

Posteriorly Augmented Anastomotic Ureteroplasty with Lingual Mucosal Onlay Grafts: 8-year Multi-institutional Experience in 61 Cases

Management of short bulbar urethral strictures (<2 cm) typically involves either endoscopic dilation or excision and primary anastomosis urethroplasty. While dilation is inexpensive and minimally invasive, it carries high recurrence rates. Urethroplasty is more durable but requires higher upfront resources. We conducted a decision analysis to compare the 10-year costs of both strategies. A decision tree was constructed to model stricture recurrence and complications after either index procedure. Direct institutional costs were obtained from hospital financial data and the Quebec physician fee schedule, expressed in 2023 Canadian dollars. Ten-year cumulative costs were calculated with a 3% annual discount rate. One-way sensitivity analyses varied recurrence and complication rates across published ranges. The average cost of urethroplasty was $7186.27 CAD compared with $441.20 CAD for dilation. Stricture recurrence was 15.5% after urethroplasty vs. 60%, 80%, and 95% after first, second, and third dilations, respectively. Over 10 years, cumulative costs were $21 714.04 CAD for urethroplasty and $25 037.45 CAD for dilation, with a break-even point at approximately 80 months. Across sensitivity analyses, urethroplasty became more expensive with varying complication rates, but remained cost-efficient across a range of recurrence rates. Despite higher initial expenses, urethroplasty is the more cost-efficient strategy for managing short bulbar urethral strictures. Given patients' relatively young age at diagnosis, cost benefits are likely to accrue beyond 10 years, supporting urethroplasty as the preferred definitive approach after at most one dilation attempt.

Benign esophageal strictures (BES) can decrease survival in dogs and cats. Little data is available on long-term survival after management. To describe the outcome of BES in dogs and cats treated with esophagoscopy-guided balloon dilation. Twenty-eight dogs and 4 cats with BES treated with balloon dilation. Retrospective observational study. Signalment data, BES number and etiology, submucosal injection and triamcinolone acetate dose, PEG-tube placement, and number of dilations were recorded. The owners were contacted to obtain survival data and diet information. Median (interquartile range) values for dogs were age, 6.5years (2.0-8.8); body weight, 7.0kg (3.0-20.8); number of BES present at initial visit 1 (1-2). Identified causes for BES were peri-anesthetic regurgitation (20 dogs, 3 cats), esophageal foreign body (6 dogs, 1 cat), and vomiting (6 dogs). Dogs underwent a median of 2 (1-3) dilation sessions. Twenty-two dogs and 3 cats received submucosal injections of triamcinolone at a median dose of 0.45mg/kg (.31-.54). Over the study period, the timing of triamcinolone injections shifted from before balloon dilation to after the procedure. A PEG-tube was placed in 9 dogs and 1 cat. Follow-up data were obtained for 25 dogs and 3 cats. Seven dogs and 1 cat could eat kibbles. Median survival time (MST) for 25 dogs was 2746days (95% CI: 1860-3297). Balloon dilation was apparently associated with prolonged survival in dogs with BES treated at our institution, with a MST 3.2-3.8 times longer than reported in previous studies.

&lt;b&gt;Abstract. &lt;/b&gt;Biliary strictures represent one of the most common complications after liver transplantation, occurring in 10-30% of recipients and significantly affecting patient quality of life and graft function. Combined hybrid approaches are increasingly widespread in contemporary practice.&lt;br /&gt; &lt;b&gt;Objective:&lt;/b&gt; To present a case series of successful application of combined methods for biliary stricture management in patients after liver transplantation and to analyze the efficacy and safety of these approaches.&lt;br /&gt; &lt;b&gt;Methods:&lt;/b&gt; A prospective observational study of three female patients (median age 57.0±7.8 years) after orthotopic liver transplantation with biliary strictures was conducted. All underwent a combined procedure using the rendezvous technique, integrating percutaneous transhepatic and endoscopic approaches with biliary stent placement.&lt;br /&gt; &lt;b&gt;Results:&lt;/b&gt; Technical success was achieved in 100% of cases (3/3). Clinical success with bilirubin reduction &amp;gt;50% was registered in all patients (3/3, 100%). Total bilirubin decreased from 71.3±22.8 μmol/L to 58.2±18.5 μmol/L by day 7 and to 32.4±8.6 μmol/L by day 30. No serious complications were registered (0/3, 0%). Mean hospitalization was 5.3±1.5 days (range 4-7 days). Mean procedure duration was 85±15 minutes.&lt;br /&gt; &lt;b&gt;Conclusion:&lt;/b&gt; The combined method demonstrated high technical feasibility (100%), clinical efficacy (100%), and a favorable safety profile with no serious complications, showing particular effectiveness in recurrent strictures. This approach can be considered as a promising alternative to isolated interventions in treating complex anastomotic biliary strictures.