Recurrent Stenosis Research Articles

The role of local expression of hormone receptors in the genesis of idiopathic tracheal stenosis.

Tracheal stenosis in adults is usually the result of mechanical injuries either from direct trauma, tracheotomy or intubation. Idiopathic stenosis in the cricotracheal section is a rare condition and occurs almost exclusively in females. Therefore, an influence of the female sexual hormones estrogen and progesterone has been assumed previously. Tracheal specimens of 27 patients who received tracheal resection for either idiopathic tracheal stenosis (ITS) (n=11) or posttraumatic tracheal stenosis (PTTS) (n=16) between 2008 and 2019 in our surgical department were included and retrospectively analyzed. Immunohistochemical staining of tracheal specimens concerning the hormone receptor status of progesterone and estrogen was performed. While post-tracheotomy stenosis occurred in males (n=6) as well as in females (n=10), none of the patients with idiopathic stenosis were males. All of the idiopathic stenosis (n=11; 100%) showed a strong expression of the estrogen receptors (ERs) in the fibroblasts and expression of progesterone receptors (PRs) in fibroblasts in 8 of 11 (72.7%). In the post-tracheotomy patients, only 3/16 (18.8%) showed slight staining of PRs and 6/16 (37.5%) of ERs. Of those, only one male patient presented with expression of ERs and PRs and another male patient presented with isolated PRs. Oral intake of hormone compounds was seen in 11/27 (40.7%) patients: 7/11 (63.6%) in the ITS group and 4/16 (25%) in the PTTS (noteworthy that the PTTS group included 6 male patients). Although the number of patients is small, our results show that the expression of female sexual hormone receptors in the fibroblasts of the trachea is a persistent finding in ITS. Surgery provided good results with a favorable long-term outcome without recurrence of stenosis for ITS and PTTS. Further investigation with a special focus on hormones is needed to assist in the prevention of this rare disease.

What Is the Optimal Mitral Valve Repair for Isolated Posterior Leaflet Prolapse to Achieve Long-Term Durability?

Background This study assessed risk factors for mitral regurgitation (MR) recurrence or functional mitral stenosis during long-term follow-up in patients undergoing mitral valve repair for isolated posterior mitral leaflet prolapse. Methods and Results We assessed a consecutive series of 511 patients who underwent primary mitral valve repair for isolated posterior leaflet prolapse between 2001 and 2021. Annuloplasty using a partial band was selected in 86.3%. The leaflet resection technique was used in 83.0%, whereas the chordal replacement without resection was used in 14.5%. Risk factors were analyzed for MR recurrence ≥grade 2 or functional mitral stenosis with mean transmitral pressure gradient ≥5 mm Hg using a multivariable Fine-Gray regression model. The 1-, 5-, and 10-year cumulative incidence of MR ≥grade 2 was 7.8%, 22.7%, and 30.1%, respectively, whereas that of mean transmitral pressure gradient ≥5 mm Hg was 8.1%, 20.6%, and 29.3%, respectively. Risk factors for MR ≥grade 2 included chordal replacement without resection (hazard ratio [HR], 2.50, P<0.001) and larger prosthesis size (HR, 1.13, P=0.023), whereas factors for functional mitral stenosis were use of a full ring (partial band versus full ring, HR, 0.53, P=0.013), smaller prosthesis size (HR, 0.74, P<0.001), and larger body surface area (HR, 3.03, P=0.045). Both MR ≥grade 2 and mean transmitral pressure gradient ≥5 mm Hg at 1 year post surgery were significantly associated with the long-term incidence of reoperation. Conclusions Leaflet resection with a large partial band may be an optimal strategy for isolated posterior mitral valve prolapse.

Balloon Dilatation in the Management of Congenital Obstructive Lesions of the Heart: Review of Author's Experiences and Observations-Part I.

Balloon dilatation techniques became available to treat congenital obstructive lesions of the heart in the early/mid-1980s. The purpose of this review is to present the author's experiences and observations on the techniques and outcomes of balloon dilatation of pulmonary stenosis (PS), aortic stenosis (AS) and aortic coarctation (AC), both native and postsurgical re-coarctations. Balloon dilatation resulted in a reduction of peak pressure gradient across the obstructive lesion at the time of the procedure as well as at short-term and long-term follow-ups. Complications such as recurrence of stenosis, valvar insufficiency (for PS and AS cases) and aneurysm formation (for AC cases) have been reported, but infrequently. It was recommended that strategies be developed to prevent the reported complications.

Sutureless Repair of Extracardiac Univentricular Total Anomalous Pulmonary Venous Connection

BackgroundThis study aimed to evaluate the results of sutureless repair of extracardiac total anomalous pulmonary venous connection (TAPVC) with a functional single ventricle at a single institution, including changes in the anastomotic site over time. MethodsThe database contained 98 patients with single-ventricle anatomy who underwent extracardiac TAPVC repair from 1996 to 2022. The median age and body weight at surgery were 59 days and 3.8 kg, respectively. Eighty-seven patients had heterotaxy syndrome, and 42 had preoperatively obstructed TAPVC. Primary sutureless repair was performed in 18 patients, 13 of whom were neonates. The cross-sectional area of the anastomotic site of the atrium and pericardium was divided by the body surface area, and the changes in this value over time were assessed. The median follow-up was 5.2 years (range, 0-19.4 years). ResultsOperative mortality and late mortality occurred in 2 (2.0%) and 38 (38.8%) patients, respectively. The actuarial survival rate at 5 years postoperatively was 56.2%. Multivariate analysis identified preoperatively obstructed TAPVC as a risk factor for mortality. Recurrent pulmonary venous stenosis (PVS) developed in 25 patients, thus giving a 5-year rate of freedom from PVS of 64.9%. Multivariate analysis revealed that sutureless repair significantly decreased the incidence of recurrent PVS. The cross-sectional anastomotic area tended to grow in accordance with the patients’ growth. ConclusionsSutureless repair of extracardiac TAPVC with univentricular anatomy achieved acceptable results. The anastomotic site tended to grow over time and contributed to a decline in the rate of recurrent PVS.

(256) Sexual Function and Andrology Parameters in Men after Treatment of Anterior Urethral Strictures with the Optilume Drug Coated Balloon

Abstract Introduction The Optilume Urethral Drug Coated Balloon (DCB) is a novel endoscopic treatment for recurrent male anterior urethral strictures. An important topic of discussion with patients during counseling on treatment options includes the potential affect of treatment on sexual function and fertility. The ROBUST III study was a prospective, randomized study comparing standard of care endoscopic therapy against treatment with the Optilume DCB. Assessments included evaluation of sexual function and andrology parameters. Objective The objective was to study the potential affect of treatment with the Optilume DCB on sexual function and, for younger patients, fertility. Methods A total of 79 men were randomized to receive treatment with the Optilume DCB. Sexual function was assessed via the 15 item International Index of Erectile Function (IIEF) questionnaire. Erectile function, orgasmic function, and overall satisfaction sub-domains were assessed at 3, 6, and 12 months after treatment in patients that were sexually active at baseline. Fifteen additional subjects were enrolled in a non-randomized pharmacokinetic sub-study that included assessments of paclitaxel concentration in semen and sperm quality parameters through 6 months post-treatment. Results Average erectile function and overall satisfaction scores improved from baseline to 12 months post-treatment, while orgasmic function was not changed (Figure). The improvement in satisfaction was statistically significant at 12 months (p=0.003). No adverse events of de novo erectile or ejaculatory dysfunction were reported. Average ejaculate sperm concentration did not change from baseline to 6 months (49 million/mL vs 46.6 million/mL, p=0.88), nor did total spermatozoa per ejaculate (107.2 million vs 104.0 million, p=0.94). Paclitaxel concentration in semen after treatment was maximal at 30 days (2.99 ng/mL) and was reduced near the limit of quantitation of the analytical method by 6 months (0.12 ng/mL). Conclusions Treatment of male anterior urethral strictures with the Optilume DCB did not appear to have an impact on sexual function as measured by the IIEF and adverse event assessments. Average sperm quality parameters did not differ from baseline to 6 months post-treatment. Low levels of paclitaxel were detected in semen after treatment but were nearly undetectable by 6 months. Disclosure Yes, this is sponsored by industry/sponsor: Urotronic Inc. Clarification Industry funding only - investigator initiated and executed study. Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Sci, Coloplast, Medtronic USA Inc., PROCEPT BioRobotic Corporation, NeoTract Inc., Janssen Biotech Inc., Endo Pharmaceuticals Inc., Tolmar Pharmaceuticals, Inc., 180 Medical Inc., AbbVie Inc., Pfizer Inc., Bluewind Medical, Astellas Pharma US Inc., Antares Pharma Inc., Axonic Modulation Technologies Inc., Allergan Inc., Terumo Medical Corporation, Dendreon Pharmaceuticals llc, Blue Earth Diagnostics Limited, Ferring Pharmaceuticals Inc., Olympus America Inc., Karl Storz Endoscopy-America, Clovis Oncology Inc., Dornier MedTech America Inc., Travere Therapeutics Inc., Valeant Pharmaceuticals North America LLC

Risk factors for recurrent stenosis after balloon dilation for benign hepaticojejunostomy anastomotic stricture.

Hepaticojejunostomy anastomotic stricture (HJAS) is a feared adverse event associated with hepatopancreatobiliary surgery. Although balloon dilation for benign HJAS during endoscopic retrograde cholangiopancreatography with balloon-assisted enteroscopy has been reported to be useful, the treatment strategy remains controversial. Therefore, we evaluated the outcomes and risk factors of recurrent stenosis after balloon dilation alone for benign HJAS. We retrospectively analyzed consecutive patients who underwent balloon-assisted enteroscopy-endoscopic retrograde cholangiopancreatography for benign HJAS at our institution between July 2014 and December 2020. Forty-six patients were included, 16 of whom had recurrent HJAS after balloon dilation. The patency rates at 1 and 2 years after balloon dilation were 76.8% and 64.2%, respectively. Presence of a residual balloon notch during balloon dilation was an independent predictor of recurrence (hazard ratio, 2.80; 95% confidence interval, 1.01-7.78; p=0.048), whereas HJAS within postoperative 1 year tended to be associated with recurrence (hazard ratio, 2.43; 95% confidence interval, 0.85-6.89; p=0.096). The patency rates in patients without a residual balloon notch were 82.1% and 73.1% after 1 and 2 years, respectively. Balloon dilation alone may be a viable option for patients with benign HJAS without residual balloon notches on fluoroscopy.

Intermediate outcome for the single-stage surgical repair of aortopulmonary window associated with interrupted aortic arch.

Aortopulmonary window (APW) associated with an interrupted aortic arch (IAA) is a rare cardiac malformation with significant mortality and morbidity. The goal of this study was to report the intermediate outcomes of single-stage repair concentrating on the surgical techniques and postoperative reintervention for this rare cardiac lesion. Eleven patients were diagnosed with IAA-associated APW and underwent single-stage surgical repair at Vietnam National Children's Hospital. The APW anatomy types were types I, II and III in 1, 4 and 6 patients, respectively. The IAA morphology was type A in 9 patients and type B in 2 patients. The median age was 27 [interquartile range (IQR) 6-79] days, and the median weight was 3.5 (IQR 2.8-4.5) kg. The aortic arch was repaired using direct end-to-side tissue anastomosis in 7 patients, and patch aortoplasty was performed in 4 patients. Six patients underwent APW closure with an intra-aortic baffle, and 5 patients required right pulmonary artery detachment and reimplantation. One early death occurred. Four patients required reinterventions: 1 patient required reoperation due to aortic stenosis and 3 required balloon angioplasty for either recurrent aortic arch stenosis (n = 1) or right pulmonary stenosis (n = 2) with a mean follow-up time of 3.1 years (IQR 0.5-4.3 years). Single-stage repair of IAA-associated APW can be achieved with good survival outcomes in children. However, the need for repeat reintervention or reoperation remains high, and the growth of both the aorta and pulmonary arteries should follow carefully as the patient grows. VNCH-RICH-18-96.

Transurethral incision of the bladder neck in recurrent bladder neck stenosis

BACKGROUND: Transurethral incision of the bladder neck is one of the main methods of correction of bladder neck stenosis that occurred after treatment of patients with benign prostatic hyperplasia. This technique involves endoscopic dissection in the area of the stenosed area without removing scar tissue. Taking into account the emergence of new reconstructive methods of surgical intervention in patients with recurrent bladder neck stenosis the expediency of using transurethral incision of the bladder neck in recurrent cases remains a subject of discussion.&#x0D; AIM: The aim of the study is to evaluate the effectiveness of the use of transurethral incision of the bladder neck in patients with recurrent bladder neck stenosis.&#x0D; MATERIALS AND METHODS: The study included 30 patients with a diagnosis of recurrent bladder neck stenosis who were treated in the period from 2012 to 2022. in Clinical Hospital of St. Luke and was performed transurethral incision of the bladder neck using bipolar electrosurgical energy. The diagnosis of bladder neck stenosis was established on the basis of complaints, anamnesis, uroflowmetry with determination of the volume of residual urine, ureteroscopy, retrograde urethrography. Recurrence was recorded when the maximum urination rate below 12 ml/s, there was an episode of acute urinary retention, or the need for additional surgical intervention for bladder outlet obstruction.&#x0D; RESULTS: All 30 patients underwent transurethral incision of the bladder neck using bipolar electrosurgical energy. The average duration of surgery was 22.9 minutes. The degree of postoperative complications did not exceed grade II according to the Clavien scale. The frequency of de novo stress urinary incontinence was detected only in one patient, which resolved spontaneously within 6 weeks. The maximum urination rate after 3 months was 14.73 3.61 ml/s, while after 6 months there was a significant decrease to 10.91 6.92 ml/s, and after 12 months to 9.4 7, 65 ml/s. The absence of recurrence in patients after TUI BN during the observation period was noted in 17 (56.67%) patients.&#x0D; CONCLUSIONS: Transurethral incision of the bladder neck using a bipolar electrode is a safe method for correcting bladder neck stenosis, but in recurrent cases it has limited efficacy. In this regard, in patients with a large number of endoscopic interventions in history, other methods of bladder neck reconstruction should be chosen.

Laparoscopic buccal plasty of the pyeloureteral segment and proximal ureter

BACKGROUND: With recurrent extended strictures of the pyeloureteral segment and the proximal ureter, when standard operations are ineffective or technically impossible, the narrowed area can be replaced with a flap from the cheek mucosa.&#x0D; AIM: The aim of the study is the results of laparoscopic plastic surgery of the pyeloureteral segment and proximal ureter with buccal graft.&#x0D; MATERIALS AND METHODS: Minimally invasive plastic surgery of the extended stricture of the pyeloureteral segment, upper and middle third of the ureter with a flap from the cheek mucosa was performed in 27 patients. There were 16 men, 11 women, and the average age was 51 years. The cause of narrowing in 16 patients was previously performed pyeloplasty, in 10 contact ureterolithotripsy in the proximal ureter, in 1 his injury during laparoscopic excision of a parapelvical kidney cyst. Laparoscopic access was used in 24 patients, and robot-assisted access was used in 3 patients. In 17 of them, the narrowed area was replaced by the onlay technique, in 10 patients, anastomosis augmentation was performed with a buccal graft.&#x0D; RESULTS: There were no intraoperative complications. The duration of operations ranged from 115 to 340 minutes. There were no cases of urine leaking through the drainage. Fever up to 38.0 C was observed in 5 (18.5%) patients, 3 (11.1%) of them underwent antibacterial therapy (grade II according to Clavien), and 2 (7.4%) without nephrostomy drainage, puncture nephrostomy (grade IIIa according to Clavien) was performed. There were no complications according to Clavien IIIb degree. On excretory urograms and computed tomography, the area of the ureter replaced by a buccal flap is wide and well passable. In patients with pyeloureteral segment strictures, a decrease in the size of expanded cups and pelvis was observed in dynamics. Clinically, all operations were successful, as it was possible to relieve patients from nephrostomy drainage and symptoms of upper urinary tract obstruction.&#x0D; CONCLUSIONS: Buccal ureteroplasty may be the method of choice in patients with extensive narrowing of the pyeloureteral segment and proximal ureter. It is a relatively simple operation and does not require extensive mobilization of the ureter and provides good functional results.

Balloon angioplasty versus stent placement for the treatment of portal vein stenosis in children: a single center experience.

To evaluate the safety and efficacy of percutaneous interventional treatment of portal vein stenosis in children. A retrospective analysis of all interventional treatments for portal vein stenosis in pediatric patients at a single institution from 2010 to 2021 was conducted. Platelet count, spleen size and portal vein flow velocity were assessed during the follow-up period. Primary and primary assisted patency time were determined. A total of ten children (median age 28.5months, interquartile range (IQR): 2.75-52.5months) with portal vein stenosis after Mesorex-Shunt (n = 4), liver transplantation (n = 3) and other etiologies (n = 3) underwent 15 interventional procedures. There were five reinterventions and one discontinued intervention. The technical success rate was 93.3% (14/15) and clinical success of treated patients was 100% (14/14). Median follow-up was 18months (IQR: 13.5-81months). The median primary patency time for stent placement was 70months (IQR: 13.5-127.25months). For balloon angioplasty, the median primary patency time was 9months (IQR 7.25-11.5months), while the median assisted primary patency time was 14months (IQR: 12 to 15months). Platelet count, spleen size and portal vein flow velocity reliably corresponded to recurrence of portal vein stenosis in asymptomatic patients during follow-up. Interventional treatment is a safe and efficient method to treat portal vein stenosis with long patency times, regardless of etiology. Primary stent placement shows a higher primary patency time than balloon angioplasty. Implementation of stent placement as the primary interventional method may improve patency times and reduce the need for repeat reinterventions in pediatric patients.

Utilization of Non-Transecting Pyeloplasty Techniques for Management of Recurrent Ureteropelvic Junction Obstruction

Introduction: Cases of recurrent ureteropelvic junction obstruction (UPJO) in patients who underwent a prior failed pyeloplasty may pose a difficult challenge for urologists. The increased findings of periureteral fibrosis and scarring in a reoperative field may increase the risk of ureteral devascularization and stricture recurrence. The goal of this study is to demonstrate three robotic non-transecting pyeloplasty techniques for patients in this setting. Methods: We conducted a retrospective review of our Collaborative of Reconstructive Robotic Ureteral Surgery (CORRUS) database for all consecutive patients between April 2012 and September 2019 who underwent a secondary pyeloplasty for management of a recurrent UPJO after prior failed pyeloplasty. Transecting (dismembered) and non-transecting pyeloplasty (YV plasty, buccal mucosa graft ureteroplasty onlay, or Heineke–Mikulicz) were the techniques used for secondary pyeloplasty. YV plasty was utilized in patients with high insertion UPJO without a redundant renal pelvis. A buccal mucosa graft ureteroplasty onlay was utilized for patients with nonobliterative long-segment UPJO and/or significant peri-ureteropelvic junction fibrosis. The Heineke–Mikulicz technique was utilized in patients with short-segment (≤1.5 cm) UPJO. Symptomatic absence of flank pain and radiographic obstruction (computed tomography urogram, renal scan, and/or renal ultrasound) were measures used to assess for postoperative success. Using a p < 0.05 for statistical significance, we used nonparametric independent sample median tests and chi-square tests to compare perioperative variables between transecting and non-transecting pyeloplasty. Results: Twenty-eight patients met the final inclusion criteria. Regarding preoperative variables, there was no difference in median operative time (p = 0.26) and estimated blood loss (p > 0.99) between both groups. In the non-transecting group, near-infrared fluorescence with indocyanine green was utilized more frequently (85.7% vs. 50.0%, p = 0.04). The non-transecting group also had a longer median stricture length (2.8 cm vs. 1.1 cm, p = 0.04). There was no difference in surgical success rates between both groups (85.7% for both groups, p > 0.99). Two patients who underwent a non-transecting buccal mucosa graft ureteroplasty onlay required postoperative management with percutaneous nephrostomy tubes caused by recurrent obstruction. Regarding postoperative variables, there was no difference in surgical success rates between both groups (p > 0.99). Conclusions: In patients with recurrent ureteropelvic junction obstruction after prior failed pyeloplasty, non-transecting pyeloplasty techniques, including YV plasty, buccal mucosa graft ureteroplasty onlay, and Heineke–Mikulicz pyeloplasty, are safe and feasible options. Given the potential technical challenges involved with secondary repair, non-transecting pyeloplasty techniques may offer benefits in reducing the risk of ureteral devascularization and preserving the fragile ureteral blood supply. J.J., M.L., J.K., and L.C.Z. have no conflicts of interest to disclose. M.D.S. is on the Scientific Advisory Board for Intuitive, a consultant for VTI Medical, and performs educational activities for Ethicon. D.D.E. is a paid speaker, consultant, and proctor for Intuitive Surgical, consultant for Johnson and Johnson, and founder/part owner of Melzi Corp. Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. The study was approved by the Institutional Review Board at Temple University (protocol number 20793). Runtime of video: 7 mins 15 secs This material was presented at the American Urological Association Conference in 2021 (https://doi.org/10.1097/JU.0000000000002052.04).

Management of biliary complications in liver transplant recipients using a fully covered self-expandable metal stent with antimigration features.

Following liver transplant (LT) with duct-to-duct anastomosis, biliary strictures and leaks are typically managed with endoscopic retrograde cholangiopancreatography (ERCP) and stenting. While multiple side-by-side plastic stents are typically used for management of anastomotic strictures, fully covered self-expandable metal stents (FCSEMS) can be used to decrease the number of ERCPs with longer periods of stent patency. The risk of migration can limit their use. FCSEMS with antimigration fins to manage benign biliary complications following LT may provide stricture resolution with limited adverse events (AEs). Single center retrospective study of LT patients who required FCSEMS from 1/2014 to 4/2022. Primary outcomes included stricture resolution and recurrence. Secondary outcomes were stent migration, occlusion, removability, and number of ERCPs. Forty-three patients (mean age 55.5 years) with anastomotic strictures (N.=37), bile leaks (N.=4) or both (N.=2) were included. The median time from LT to FCSEMS placement was 125 days. Within one year of LT, 31 patients required intervention; early intervention at less than 30 and 90 days was needed in 7 and 19 patients, respectively. The median length of follow-up was 816.5 days. Stricture resolution was seen in 35 patients (81%) after a median stent dwell time of 130.5 days; recurrence occurred in 8 patients. There were three instances of partial stent migration that did not require reintervention or interfere with removability. The mean number of ERCPs required was 2.5. The use of a FCSEMS with antimigration features yields effective stricture resolution with longer stent dwell times and fewer ERCPs.

Outcome of Urethroplasty in Management of Urethral Stricture: Experience at Institute of Kidney Diseases Hayatabad Peshawar

Objective: To determine the frequency of successful outcomes of urethroplasty in the management of urethral stricture Methods: It is a descriptive study, conducted in the department of Urology at the Institute of Kidney diseases Peshawar from April 2016 to December 2019. A total number of 85 patients for urethroplasty were included in the study by non-probability convenient sampling. The entire pre-operative, per-operative, and postoperative data were collected on structured proforma and analyzed on SPSS®, version 20.0. Results: The mean age of the patient in this study was 41 years. Regarding etiology, External trauma was the major cause in the form of road traffic accidents in 38.82% while straddle urethral injury in 29.41% of patients, other less frequent causes included iatrogenic urethral trauma and infective stricture. The bulbar urethral stricture was found in 55.29% of cases, with proximal penile and bulboperineal accounting for 23.52% and 21.17% respectively. Significant past surgical history found was suprapubic catheterization in 100%, a failed primary attempt of internal optical urethrotomy (IOU) in 29.41%, multiple recurrences in 48.23%, and re-do urethroplasty in 10.58% of cases. The most common procedure performed was end-to-end anastomotic urethroplasty in 81%, other procedures included penile flap urethroplasty, pull-through procedure, and 10.58% of cases required pubectomy. Urethroplasty was found highly successful in 94% of mean follow-ups 15 months. The cause of failure was wound infection in 1, UTI in 2, and necrosis of penile skin flap in 2 patients. Conclusion: Our initial results conclude that anastomotic urethroplasty is an effective and mainstay treatment modality in the management of urethral stricture disease. It bears less rate of recurrence of urethral stricture. Keywords: Urethroplasty, urethro stricture, Recurrence

Lateral incision 1-stage urethroplasty with oral mucosal graft for patients with penile urethral stricture after hypospadias repair—a preliminary report

PurposeTo report our early experience of a novel surgical approach for penile urethral strictures after hypospadias repair, using a lateral incision to keep the ventral tissue and vasculature of the penis intact and to avoid the need for tissue interposition.Patients and methodsA total of 21 patients underwent lateral incision 1-stage urethroplasty with oral mucosal graft. The median age of the patients was 21 years old (range, 13–47). The median number of prior procedures for hypospadias repair was 3 (range, 1–9) with 18 of 21 patients (85.7%) undergoing greater than 1 prior reconstructive procedure. The mean length of the penile urethral strictures was 4.5 ± 1.7 cm, with a range of 1.0 to 8.0 cm. Selection criteria for lateral incision 1-stage urethroplasty include: non-obliterative stricture, no or mild penile curvature and no urethrocutaneous fistula.ResultsMedian follow-up was 30 months (range, 6–73). Success was achieved in 17 of 21 patients (80.9%). The 4 (19.0%) patients with treatment failure developed recurrent urethral strictures. Of the 4 men with recurrent strictures, 3 were ultimately treated successfully by DVIU (2) or two-stage urethroplasty (1), and one patient chose repeated dilation.ConclusionsFor patients with penile urethral stricture after hypospadias repair with non-obliterative stricture, no significant penile curvature and no urethrocutaneous fistula, a lateral approach with oral mucosal graft is a simple technique that avoids the need for tissue interposition and keeps the penile ventral tissue and vasculature intact, resulting in a low risk of complications.

Use of a novel biliary stent to prevent distal stent migration in benign anastomotic stricture.

Endoscopic treatment using balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (ERCP) is useful for hepaticojejunostomy anastomotic strictures. Although biliary stent placement is conducted to avoid stricture recurrence or realize stricture resolution after balloon dilation [1] [2], distal stent migration is a common problem [3] [4].

Male Urethral Stricture in Patients with Metabolic Syndrome.

Urethral stricture is characterized by fibrosis that decreases urine flow. Metabolic syndrome is a complex disorder that causes fibrosis in many organs. This study aimed to evaluate the relationship between metabolic syndrome and appearance of urethral stricture and effects of metabolic syndrome on the recurrence of urethral stricture in patients with primary urethral stricture who underwent direct visual internal urethrotomy. One hundred thirty-two male patients who underwent direct visual internal urethrotomy between 2014 and 2021 because of primary urethral stricture were included. Location, length, and type of urethral stricture, time from diagnosis to surgery, postoperative follow-up, time from surgery to recurrence, and postoperative follow-up duration with a urethral catheter were retrospectively analyzed and association with metabolic syndrome was evaluated. The mean age was 50.48 ± 17.94 years. Recurrence was found in 34.1% and metabolic syndrome in 27.3%. Postoperative follow-up duration was significantly longer in patients with recurrence than in those without (P=.033). There was no statistically significant difference in terms of metabolic syndrome and postoperative urethral catheterization between patients with and without recurrence (P=.126, P=.714, respectively). Postoperative clean intermittent self-catheterization use was found to be statistically higher in patients with recurrence than in patients without recurrence (P=.018). Postoperative urinary tract infection rate was found to be significantly higher in patients with metabolic syndrome compared to patients without metabolic syndrome (P=.001). Metabolic syndrome was not associated with recurrence. However, postoperative urinary tract infections were more common in patients with metabolic syndrome than in patients without. Clean intermittent self-catheterization used postoperatively may increase the risk of stricture.

COMPARISON OF RECURRENCE OF URETHRAL STRICTURE AFTER INTERNAL OPTICAL URETHROTOMY WITH AND WITHOUT POST-OPERATIVE ORAL STEROIDS IN DISTRICT DERA ISMAIL KHAN

Urethral stricture is one of the most common diseases in urology. The urethral structure is the narrowing of the urethral lumen due to spongiofibrosis. It is notorious for its recurrence and accounts for the major burden on the Urology department. Internal optical urethrotomy is considered the first line of treatment for urethral stricture. When combined with clean intermittent self-catheterization, and Intralesional injections, better results could be obtained. This study compares the recurrence of urethral stricture after internal optical urethrotomy with and without post-operative oral steroids in the population of Dera Ismail Khan. The study was a non-randomized control trial done in the Urology Department, DHQ/MTI-TH, Dera Ismail Khan, Pakistan, from January 2021 to June 2021. The patients from the urology outdoor and emergency of DHQ Teaching Hospital were included in the study. A total of 152 patients were divided by lottery method into two groups’ an experimental group and Control group, each containing 76 patients. After losing follow-up, the remaining patients who completed the study were 128. The patients in both groups underwent internal optical urethrotomy with a cold knife. The experimental group of patients received oral steroids for 4 weeks. The control group didn’t receive steroids after the procedure. The mean age in the experimental group was 41 ± 09 years, while in the control group, it was 36 ± 13 years. After 6 months, the recurrence was observed in 12 patients (18.75%) in the experimental group and 25 in the control group (39.06%). These results showed a statistically significant difference in recurrence rate between these two groups with a p-value of 0.0123. Based on the results, it can be concluded that the use of oral steroids after internal optical urethrotomy decreases the risk of recurrence of urethral stricture significantly.

Economic evaluation of Optilume, a drug-coated balloon for recurrent anterior male urethral stricture.

We aim to conduct an economic evaluation of the Optilume urethral drug-coated balloon (DCB) compared with endoscopic management for the treatment of recurrent anterior male urethral stricture in England. A cohort Markov model was developed to estimate the costs and savings to the NHS over a 5-year time horizon of adopting Optilume for the treatment of anterior urethral male stricture versus current endoscopic standard of care. A scenario analysis was conducted which compared Optilume to urethroplasty. Probabilistic and deterministic sensitivity analyses were performed to estimate the impact of uncertainties in model parameters. When compared with current endoscopic standard of care Optilume resulted in an estimated cost saving of £2502 per patient if introduced in the NHS for the treatment of recurrent anterior male urethral stricture. In the scenario analysis, the use of Optilume compared with urethroplasty resulted in an estimated cost saving of £243. Results were robust to changes in individual input parameters as demonstrated in the deterministic sensitivity analyses, with the monthly probability of symptom recurrence associated with endoscopic management the only exception. Probabilistic sensitivity analysis results demonstrated that Optilume was cost saving in 93.4% of model iterations, when running 1000 iterations. Our analysis suggests that the Optilume urethral DCB treatment can be a cost-saving alternative management option for the treatment of recurrent anterior male urethral stricture within the NHS in England.

Recurrent Esophageal Stricture as a Result of Esophageal Diverticulum: Case Report

Esophageal stricture is a disorder that limiting patients’ capability to get adequate intake. Dysphagia and regurgitation are main problem that makes patient admit to the hospital. There are several causes that narrowing esophageal lumen; those could be intraluminal or extraluminal. Esophageal diverticulum is one of a kind. It is not easy to establish the diagnosis of diverticulum in esophagus segment since supporting examination needed were complex. Esophageal stricture treatment should be interdisciplinary approach because inappropriate management would increase risk of complication and lowering patient’s quality of life. The management of esophageal diverticulum could be challenging and its prognosis depends on the patient’s characteristic and comorbidity.

A comparative study of two single-stage oral mucosal substitution urethroplasty (Kulkarni and Asopa) in the surgical treatments of lichen sclerosus urethral strictures.

Long-segment lichen sclerosus (LS) urethral stricture is a challenge for urologists. Limited data are available for surgeons to make a surgical decision between Kulkarni and Asopa urethroplasty. In this retrospective study, we investigated the outcomes of these two procedures in patients with LS urethral stricture. Between January 2015 and December 2020, 77 patients with LS urethral stricture underwent Kulkarni and Asopa procedures for urethroplasty in the Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine (Shanghai, China). Of the 77 patients, 42 (54.5%) underwent the Asopa procedure and 35 (45.5%) underwent the Kulkarni procedure. The overall complication rate was 34.2% in the Kulkarni group and 19.0% in the Asopa group, and no difference was observed ( P = 0.105). Among the complications, no statistical difference was observed in the incidence of urethral stricture recurrence ( P = 0.724) or glans dehiscence ( P = 0.246) except for postoperative meatus stenosis ( P = 0.020). However, the recurrence-free survival rate between the two procedures was significantly different ( P = 0.016). Cox survival analysis showed that antiplatelet/anticoagulant therapy use ( P = 0.020), diabetes ( P = 0.003), current/former smoking ( P = 0.019), coronary heart disease ( P < 0.001), and stricture length ( P = 0.028) may lead to a higher hazard ratio of complications. Even so, these two techniques can still provide acceptable results with their own advantages in the surgical treatment of LS urethral strictures. The surgical alternative should be considered comprehensively according to the patient characteristics and surgeon preferences. Moreover, our results showed that antiplatelet/anticoagulant therapy use, diabetes, coronary heart disease, current/former smoking, and stricture length may be contributing factors of complications. Therefore, patients with LS are advised to undergo early interventions for better therapeutic effects.