Internationally, there is a trend towards early urethroplasty for treatment of urethral stricture, as opposed to endoscopic management, which is associated with short-lived patency and frequent retreatments. The objective of this study was to compare the outcomes of urethral stricture management before and after gaining urethral reconstruction expertise through a fellowship programme. This was a retrospective case-control study that compared the characteristics, management, and outcomes of urethral stricture disease managed over two consecutive periods of time-pre-fellowship period (September 2016 to September 2019) and the post-fellowship period (October 2019 to September 2022). There were 37 patients in the pre-fellowship group and 30 patients in the post-fellowship group. Regarding treatment choice, the proportion of patients undergoing index urethroplasty significantly increased from 2.7% to 36.7% [odds ratio (OR) 18.9, 95% confidence interval (CI): 2.7 to 209.8, P<0.008], due to early recognition of strictures not amenable endoscopic treatment. Retreatment became less frequent post-fellowship (37.8% vs. 16.7%, OR 2.99, 95% CI: 1.6 to 5.9, P=0.001). Average number of procedures per patient also reduced (1.65±0.98 vs. 1.23±0.63, P=0.04). Also, there was a trend towards improved overall patency rate at 6-month in the post-fellowship period compared to the pre-fellowship group. This study has demonstrated that urethral reconstruction expertise was correlated to the increased exposure of urethral stricture patients to urethroplasty as a more efficacious procedure, and was associated with reduced retreatment rates. The expertise can bring cost benefits for patients and regional institutions.

History of urethral surgery: Lessons learnt from the past.

Introduction Balanitis xerotica obliterans (BXO) can cause phimosis, meatal stenosis, and urethral strictures. However, management of these conditions in BXO patients is difficult. Surgical interventions, with their own risks and complications, demonstrate higher rates of disease recurrence. Recently, topical applications of steroids and immunomodulators have been evaluated for their role in the management of urethral strictures associated with BXO. In this study, we evaluated the role of topical application of tacrolimus in urethral strictures associated with BXO. Materials and methods This was a prospective study on male patients having urethral strictures associated with BXO. Patients were thoroughly evaluated and advised topical application of 0.1% tacrolimus. They were then reevaluated at six weeks. If the effects of tacrolimus were found to be satisfactory, then patients were advised to continue this treatment for three months. After three months, the patients were again evaluated. At the time of each reevaluation, changes in uroflowmetry and International Prostate Symptom Score (IPSS) were noted. Results A total of 53 patients were included in this study. The mean values of pre- and post-tacrolimus maximum urinary flow rate on uroflowmetry(Qmax) were 12.00±1.43 m/s and 15.26±3.14 m/s, respectively (p<0.001). The mean values ofpre- and post-tacrolimus IPSS scores were 18.55±2.28 and 13.04±4.72, respectively (p<0.001). Based on the results, the application oftacrolimus was found to be ineffective in those with strictures >2 cm in length. Of the 53 patients included in the study, 21 required surgical intervention, as their response to tacrolimus was unsatisfactory. Conclusion Topical application of tacrolimus is a safe and feasible treatment option for short-segment (≤2cm) urethralstrictures associated with BXO.

Background: Oesophageal strictures in children are either acquired or congenital. The common acquired causes include ingestion of corrosive agents. Oesophageal strictures in children can lead to devastating complications or even death as they pose treatment challenges, especially in developing countries where conservative oesophageal dilation, which may reduce the post-treatment morbidity associated with surgical intervention, is not readily available. Objective: This study demonstrates the successful management of oesophageal strictures in a low-resource setting. Methods: This is a retrospective study of 66 consecutive children with oesophageal strictures who were evaluated and had endoscopy oesophageal dilation from February 2016 to February 2024 at the Paediatric Endoscopy Unit of the Korle Bu Teaching Hospital (KBTH), Accra Ghana. Results: Four hundred and eighty (480) dilation sessions were done in 57 patients. Most of the children were between 1 and 5 years old, and 57.6% (n = 38) were male. Forty-seven (71.2%) of the strictures were due to ingestion of caustic agents. Fifty-one (89.5%) patients had successful dilatation, and six were lost to follow-up. There were three (0.6%) complications of oesophageal perforations. Conclusion: Oesophageal stricture is common in children, and accidental ingestion of corrosive substances is the most common cause. Endoscopy dilation of oesophageal strictures can safely be done in most children, with excellent outcomes and low complication rates.

Abstract Background Ureteral stricture is a prevalent and complex condition within the urinary system, often leading to significant complications. In severe instances can result in renal insufficiency and damage. Although various treatment options exist for ureteral strictures,but effectively managing specific cases remains a challenge. Autologous grafts have emerged as a novel surgical approach for ureteral repair and reconstruction. However, due to the specific surgical conditions required, reports of complications associated with these techniques are relatively limited. Case Presentation This article presents a case of a long-segment ureteral stricture treated with lingual mucosal graft. The patient experienced postoperative severe renal hemorrhage, prompting a thorough analysis of the factors contributing to this complication. This case highlights the complexities involved in the surgical management of ureteral strictures and underscores the need for careful patient selection. Conclusion The use of lingual mucosal grafts in the treatment of ureteral strictures demonstrates potential benefits, but the risk of postoperative complications, such as renal hemorrhage, necessitates further investigation. By refining the selection criteria for patients undergoing surgical intervention and addressing associated complications, this study aims to enhance clinical practice and improve patient outcomes.

This review aims to focus on what we know about the management of biliary strictures of unknown etiology, especially exploring our diagnostic armamentarium in the setting of indeterminate biliary strictures. Presently, this is a current issue that has a relevant impact both on patient prognosis, often delaying diagnosis, and on overall costs associated with repeating diagnostic procedures, sometimes performed with very expensive devices. We also focus on current biliary drainage approaches, providing an overview of therapeutic options, endoscopic or not.

Background and objective: Renal transplantation for patients with end-stage renal disease gives better long-term survival results and a better quality of life in comparison with maintenance dialysis. However, some general and urological complications may occur following kidney transplantation. One of those complications is ureteral stricture, but the harm of renal transplant can be avoided when treated in an accurate and timely manner. This study is carried out to determine the incidence of ureteral stricture of renal transplantation, and to appropriately diagnose and treat the conditions. Methods: A retrospective study extended from July 2011 to February 2021. In this period, 1840 renal transplant performed by our team in Rizgary teaching and Zheen international hospitals, all from living donors. Results: Among 1840 kidney transplant surgery, 17 patients were only admitted as ureteral stricture post-transplant operation (0.92%) that diagnosed by high serum creatinine in association with hydroureteronephrosis. Hydronephrosis subsided and renal function tests nearly normalized after drainage of transplanted kidney with percutaneous nephrostomy tube. Anastomosis site stricture was observed in 16 patients (94.1%), they were treated by ureteral re-implantation. DJ-stenting and upper ureteric stricture was observed in only one patient (5.9%) that treated through pyeloplasty technique. Conclusion: Surgical treatment is the best choice of patients with ureteral stricture, post renal transplantation. For low grade stricture, endoscopic treatment may be offered although the rate of success is not high.

Abstract The management of post-cholecystectomy biliary strictures remains challenging. While endoscopic and percutaneous biliary procedures have shown high success rates in treating these benign biliary strictures, sometimes the guidewire cannot be negotiated across the stricture, making the stricture refractory to management by the endoscopic or percutaneous route. Magnetic compression anastomosis is a nonsurgical alternative used on the endoscopic and percutaneous biliary platform to create a passage across the refractory biliary stricture. We report three cases of uncrossable bile duct strictures managed with magnetic compression anastomosis. This report highlights the utility of a relatively simple technique for managing complex problems.

The most common symptom of chronic pancreatitis is abdominal pain. Potential causes include ductal hypertension due to pancreatic stricture, bile duct stricture, duodenal stricture, the presence of a pseudocyst, and increased nociception. In the management of main pancreatic ductal strictures associated with chronic pancreatitis, an endoscopic pancreatic sphincterotomy is typically performed, followed by stricture dilation and the insertion of a single plastic stent. If pancreatic stones are present, extracorporeal shockwave lithotripsy may also be necessary. After placing a plastic stent in the pancreatic duct, regular stent exchanges should be performed, maintaining stenting for approximately 1 year. For refractory pancreatic ductal stricture, the placement of multiple plastic stents or a fully covered metal stent may be considered. Although metal stents are effective, they are associated with a higher risk of adverse events, including stent migration, bile duct obstruction, and the formation of de novo pancreatic ductal strictures. This review discusses the endoscopic management of benign pancreatic ductal stricture associated with chronic pancreatitis.

Introduction: To investigate preoperative predictors of surgical success for patients undergoing robotic ureteral reconstruction (RUR) for management of distal ureteral strictures. Methods: We retrospectively reviewed our multi-institutional Collaborative of Reconstructive Robotic Ureteral Surgery database to identify all consecutive patients undergoing RUR for surgical repair of distal ureteral strictures between 04/2012 and 12/2022. Procedures included refluxing reimplant (58.5%), side to side reimplant (18.0%), ureteroureterostomy (12.7%), non-refluxing reimplant (6.3%), buccal mucosa ureteroplasty (2.8%), and appendiceal bypass ureteroplasty (1.7%). Patients were grouped according to whether they were surgically successful. Preoperative variables between both groups were compared using chi-square tests. All variables with associations of p < 0.2 underwent a binary logistic regression analysis to determine predictive variables of success for RUR (p ≤ 0.05 considered statistically significant). Results: Overall, 284 patients met inclusion criteria. Univariate analysis showed obesity (p = 0.03), smoking history (p = 0.10), abdominopelvic radiation history (p = 0.14), immunocompromised state (p = 0.12), and ureteral rest (p = 0.01) were notable preoperative factors (p < 0.2). Binary logistic regression analysis further revealed the odds of surgical success in patients with obesity was 0.32 times (CI: 0.12-0.83, p = 0.02) the odds of success for patients without obesity. The odds of surgical success in patients who underwent preoperative ureteral rest was 4.2 times (CI: 1.51-11.77, p < 0.01) the odds of success for patients who did not undergo preoperative ureteral rest. Conclusion: Preoperative factors including obesity and ureteral rest may affect surgical success of RUR for management of distal ureteral strictures.

The management of complicated and irreparable urethral strictures can be challenging, and continent urinary diversion has emerged as a viable option. This study aims to investigate the complications associated with continent urinary diversion using the Mitrofanoff principle in patients with complex urethral strictures that cannot be corrected through urethroplasty surgery. A total of 22 patients were included in this study, who underwent continent urinary diversion surgery using the Mitrofanoff technique. The patients were monitored for post-surgical complications over an average follow-up period of 28.36±14.26 months. Surgical failure was defined as the inability to completely and regularly empty urine from the new urinary tract. Half of the patients experienced surgical complications, with only one case resulting in surgery failure. The most common complication observed was stoma stenosis. Two patients reported slight urinary leakage from the stoma site. Notably, all patients except one, regained control over their urine after the procedure. Early therapeutic interventions were classified according to the Clavien-Dindo grading system, showed that none of the patients experienced severe complications (grade 4 or 5). The study examines the outcomes of continent urinary diversion using the Mitrofanoff technique in adults with complex urethral strictures, providing realistic expectations of complications. Overall, the study shows that this approach is a viable option with a high success rate and manageable complication for individuals with complex urethral strictures that cannot be corrected through urethroplasty surgery.

Management of Bulbar Strictures in boys following previous Endoscopic Treatment of Posterior Urethral Valves

Historically, direct visual internal urethrotomy (DVIU) and balloon dilation (BD) have been preferred as first line interventions for certain urethral strictures. Urethroplasty is considered the gold standard following failed primary intervention; however, no recommendations exist for intervention following a failed urethroplasty.1 Thus far, DVIU and BD have been shown to display comparable outcomes as primary treatments in terms of freedom from recurrent stricture, time to recurrence, and complications.2 In this research letter, we provide evidence that in the case of secondary interventions following failed urethroplasty, BD shows significantly improved 3-year outcomes compared to DVIU. Urethral strictures are fairly common with a prevalence of 229–627 per 100 000 males.3 They typically impact men over the age of 65 and increase the risk for UTIs and incontinence. While some studies have compared the success of DVIU versus BD as primary interventions, reported success rates are highly variable with 32%–96% for DVIU and 35%–84% for BD.2, 4, 5 Conversely, urethroplasty has a high reported success rate of 96%, though is a more complicated procedure requiring longer recovery and a skilled surgeon.1 Due to the low frequency of recurrence following urethroplasty, recommendations for subsequent reoperations with DVIU or BD have not been adequately studied. Given the prevalence of urethral strictures and increasing use of urethroplasty, it is important to study the success of subsequent DVIU and BD. We performed a retrospective review using TriNetX (TriNetX, Inc., Cambridge, MA, USA), a clinical research platform that collects and stores over 125 million patients' electronic health record data, to determine whether urethroplasty patients with subsequent DVIU or BD had a higher chance of recurrent stricture. We are unaware of another study that directly compares success rates of DVIU versus BD as secondary interventions following urethroplasty. Cohorts were constructed for both DVIU following urethroplasty and BD following urethroplasty. Patient ages ranged from 21 to 90, and exclusion criteria included benign prostatic hyperplasia, neurogenic bladder and bladder neck contracture. Specific inclusion and exclusion criteria can be found in Appendix S1. Given the small sample sizes, cohorts were not matched for comorbidities. Outcomes were defined as ≥1 instance of urethral stricture or stenosis, or retention of urine between 1 month and 3 years after DVIU or BD. Outcomes were assessed with Kaplan–Meier, hazard ratios (HR) and log-rank tests to determine significance (p < 0.05), and a Kaplan–Meier curve was generated. DVIU (N = 45) had a significantly higher probability (p = 0.0353) of recurrent urethral stricture compared to BD (N = 25), with respective 3-year incidence probabilities of 95.15% and 69.05% (Figure 1). DVIU had a median survival of 99 days while BD had a median survival of 355 days. DVIU had an increased hazard compared to BD with a HR of 1.901 (95% CI: 1.034, 3.497). For both cohorts, the median time between initial urethroplasty and subsequent salvage intervention was comparable, with 177 days for DVIU and 153 days for BD. In conclusion, for patients experiencing recurrent urethral stricture post-urethroplasty, BD appears to have better 3-year outcomes compared to DVIU. Additionally, the data suggest that in the short term, BD may provide longer lasting symptom relief before recurrence of urethral stricture. Primary limitations of this study are attributed to the use of electronic health record data including: completeness and accuracy of medical records, loss to follow-up and billing code restrictions. Additionally, the heterogeneity of cohorts formed through TriNetX and not a single institution's data will have significant influence and cannot be ignored—this is of particular note given the highly surgeon and hospital-dependent outcomes of complex procedures such as urethroplasties. Lastly, due to the nature of TriNetX, we were unable to fully characterize strictures' length and location, type of urethroplasty or type of balloons used in BD. Future studies should prioritize larger sample sizes and consider a prospective randomized controlled trial to incorporate more granular data on strictures and interventional techniques, as the results of this research could change clinical management of urethral strictures. Appendix S1.: ICD and CPT Codes Used in Cohort Construction. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Purpose: The management of recurrent bulbar urethral stricture had no consensus and faced many challenges such as the risk of failure, ischemia, and sexual dysfunction. Therefore, this study aimed to assess the outcome of nontransecting anastomotic urethroplasty in recurrent bulbar urethral stricture disease (USD) less than 3 cm and its impact on sexual functions. Material and methods: This is a prospective descriptive study that included patients with recurrent bulbar USD ≤ 3 cm. Full history taking and clinical examination, including International Prostate Symptoms Score (IPSS) and International Index of Erectile Function (IIEF-5), were documented. Moreover, retrograde urethrogram, uroflowmetry, and penile Doppler were undergone. The nontransecting urethroplasty techniques were performed: Heineke-Mikulicz principle stricturoplasty for stricture ≤1 cm without excision of the stricture and nontransecting excision and primary anastomosis without transecting the corpus spongiosum for stricture 1 to 3 cm. Each patient was routinely evaluated through a 12-month follow-up using IPSS and IIEF, uroflowmetry, and postvoiding residual urine. Results: Thirty-three patients were included in the study with a mean stricture length of 1.45 ± 0.7 cm. Twelve patients had failed previous urethroplasty, while 21 patients had previous visual internal urethrotomy. Nontransecting excision and primary anastomosis in 14 patients and Heineke-Mikulicz principle stricturoplasty in 19 patients were performed. There was no recurrence of stricture urethra, except for one patient, who required visual internal urethrotomy at a 3-month follow-up, with mean postoperative IPSS of 3.04 ± 2.745, Qmax 23.89 ± 2.714 mL/s, and postvoiding residual urine 26 ± 33 cc. No significant differences were reported between pre- and postoperative IIEF (18.61 ± 5.448 versus 19.33 ± 5.599, respectively, P = 0.236). Conclusion: Nontransecting urethroplasty can achieve a high success rate in short recurrent bulbar USD without the potential sexual morbidity.

Roux-en-Y gastric bypass (RYGB) related late gastro-jejunal (GJ) strictures are often resistant to endoscopic balloon dilations. Lumen-apposing metal stents (LAMSs) have been used to treat benign strictures with favorable results. However, the data remains limited to justify LAMS use for management of post-RYGB late GJ strictures. We aim to evaluate the safety and efficacy of LAMS placement for the management of late GJ strictures that are refractory to balloon dilations in post-RYGB patients. This was a single center retrospective study that included all post-RYGB patients who underwent LAMS placement for management of late GJ strictures that had previously failed balloon dilations. Primary outcomes were technical and clinical success, and secondary outcomes were LAMS-related adverse events. A total of 28 patients underwent LAMS placement for management of GJ strictures. Median age was 60.5 (IQR 50.5, 67.0) years and majority were females (27, 96.4%). Median interval between surgery and first diagnosis of GJ stricture was 13 years (IQR 7, 17.5). 20 × 10 mm LAMS was the most used stent (n = 24, 85.7%). The median procedure time was 23.5 (IQR 14.5, 32.0) minutes. Technical and short-term clinical success of LAMS placement was 100% (95% CI 87.9-100.0). Long-term success was achieved in 19 out of 25 patients (76.0%, 95% CI 56.6-88.5) that had over 3 months follow-up after LAMS removal. Stent migration was noted in 2 (7.1%) patients, and 1 (3.6%) patient each experienced pain and minor bleeding without the need for additional interventions. No patient in our cohort required surgical revision of GJ anastomosis. Placement of LAMS is safe, technically feasible, and associated with a high clinical success rate in patients with late GJ strictures after RYGB who have failed prior balloon dilations. Placement of LAMS can be considered early in patients requiring multiple balloon dilations.

Genital surgery is often considered the final step in surgical gender-affirming treatment. Metoidioplasty is a variant where the enlarged clitoris is lengthened and straightened. The technique has several advantages but is not without complications. We evaluated the surgical outcomes after metoidioplasty from our national center from 2007 to 2020. All patients who had undergone the metoidioplasty procedure at Oslo University Hospital from January 1, 2007, to December 31, 2020, were identified by the Local Quality Register of Gender Incongruence. Demographic, clinical, and surgical variables were recorded. Statistical analysis was carried out with SPSS. A total of 84 patients were identified. The median age at the time of surgery was 27.5 years. Of 84 patients, 48 (57.1%) experienced some kind of complication after the surgery, with an average of 1.7 complications. Complications related to the urethroplasty were the most common, with strictures occurring in 19 (22.6%) patients and urethral fistulas occurring in 11 (13.1%) patients. Forty-one patients (48.8%) needed 1 or more secondary procedures. After the management of strictures and fistulas, a secondary testis implant correction was the most frequent revision procedure performed in 38.1% (32) of patients. With increasing body mass index, the risk of complications and of undergoing secondary procedures also increased significantly (P = 0.045 and 0.019, respectively). Metoidioplasty is an operation with a relatively high complication rate, mainly related to urethroplasty. There is an urgent need for future research with a focus on quality of life and long-term follow-up.

Estado actual de la formación en cirugía reconstructiva en España: resultados de una encuesta nacional

El uso de la cirugía robótica para el tratamiento de estenosis uretrales y contracturas del cuello vesical: una revisión sistemática

A decade's experience of robotic buccal ureteroplasty for post ureteroscopic laser lithotripsy induced strictures—Should this be the new standard?

Necrotizing enterocolitis (NEC) is one of the main causes of acute abdomen in neonates. Surgical treatment entails important morbidity and mortality and conservative management, when possible, offers better outcomes. Post-NEC intestinal strictures are one of the main complications. Retrospective analysis from June 2011 to November 2022 of post-NEC strictures (PNS) after conservative management of neonates diagnosed with NEC (modified Bell stage IIA or higher) at a tertiary neonatal surgery center. Out of 219 NEC, 126 received initial conservative management (57.5%), 24 (19%) of which eventually underwent surgery for PNS. Average gestational age and weight at birth of our cohort were 31.3 ± 4.9 weeks and 1,694 ± 1,009 g.PNS diagnosis was made 38.4 ± 16.5 days after the NEC episode. 6/24 (25%) were asymptomatic and diagnosed by screening enema, 11 (46%) presented signs of intestinal obstruction before the enema could be performed and 7 (29%) after a normal previous protocol study.Median age at PNS surgery was 56 ± 17.9 days. A total of 2/3 strictures were found in cecum, ascendent, and transverse colon. Primary resection and anastomosis were performed in all cases. Feeds were restarted on postoperative day 4.3 ± 2.9. Two cases presented anastomotic complications (1 dehiscence and 1 stenosis), and no deaths were recorded. PNS is a frequent complication after conservative management. Deffered surgical treatment after the acute NEC episode is resolved allows for safer surgeries (since patients have reached hemodynamical stability and overcome septic shock), shorter resections, and favorable postoperative outcomes.