Stricture Disease Research Articles

Diagnostics, reconstructive approaches, and outcomes in female urethroplasty patients.

To gain further understanding of current outcomes regarding urethroplasty for female urethral stricture disease. The European Association of Urology Section of Genitourinary Reconstructive Surgeons formed the Female Reconstruction Group to enhance multicentric collaboration, and to generate more evidence on the most effective treatment options for female patients with recurrent urethral stricture. Patients were eligible for inclusion if they had a urethral stricture and had undergone one of three reconstructive procedures, namely ventral onlay flap (VOFU), ventral onlay graft (VOGU) or dorsal onlay graft (DOGU) urethroplasty. Outcomes of specific interest were stricture-free survival and prognostic factors. Of a total of 165 included patients, the surgical techniques were VOFU, VOGU, DOGU in 17, 115 and 33 patients, respectively. The median follow-up was 29 months. The 2-year stricture-free survival rate was 73%, 86% and 80% in respectively the VOFU, VOGU and DOGU groups, with no significant difference between the groups. Prior radiotherapy (P = 0.015) was identified as an independent predictor for stricture recurrence. Female urethroplasty is a safe treatment option with excellent patency rates. Mid-term stricture-free survival rate after different types of urethroplasty is encouraging in females.

Urethral Stricture Symptom and Impact Measure Validation Study.

Urethral Stricture Symptom and Impact Measure Validation Study.

Evaluation of the etiological profile, age and findings in retrograde and voiding urethrocystography of men with urethral stricture

This study aims to establish a profile of the urethral stricture disease in the studied population, in addition to evaluating the correlation between the etiology of urethral stricture, age and findings evidenced in the retrograde and voiding urethrocystography (RVUC) examination. This observational study was conducted at a single institution and included 135 men with urethral stricture. Patient’s age and the etiology of stricture were determined. RVUC findings such as length, number, location, and degree of urethral lumen obstruction of urethral stricture, as well as other associated pathological urological findings, were also analyzed. The correlation between demographic parameters, including age and etiology, and RVUC findings was then statistically analyzed. Median age of the patients was 64 years (range: 18–89 years). The most frequent etiologies were iatrogenic (51.9%), idiopathic (20.0%), inflammatory (15.6%) and external traumatic (12.6%). The subgroup of patients over 45 years of age had higher percentages of urethral stricture regardless of the etiology. In the comparative analysis between the four etiology categories, age group and location were the two variables with a statistically significant association (p = 0.001 and < 0.001, respectively). The penile urethral segment represented almost half of the cases of stricture of inflammatory etiology (47.6%). In the membranous urethral segment, almost all cases of stricture were of iatrogenic etiology, representing 24.3% of all cases of iatrogenic etiology in the study. Comparative statistical analysis between the traumatic and non-traumatic etiology categories found that location and length were the only variables with a statistically significant association (p < 0.001 and = 0.005, respectively). In the penile urethral segment, stricture of non-traumatic etiology was the most frequent (33.3% versus 11.5%). In this study, strictures were only of traumatic etiology in the membranous (20.7%) and prostatic (6.9%) urethral segments. Strictures of non-traumatic etiology were the longest. In another supplementary analysis, a statistically significant association was evidenced between age group and the specific cause of urethral stricture (p < 0.001). Prostatectomy was the main specific cause of urethral stricture considering all age groups, representing 20.7% of all cases in the study and 25.2% of patients aged over 45 years. The idiopathic and urethral catheterization were more frequent causes proportionally in the subgroup of patients aged 45 years or less than in the subgroup aged over 45 years (41.7% versus 15.3%, 29.2% versus 6.3%, respectively). A more severe disease profile of urethral stricture was evidenced, with 83% of cases causing obstruction in more than 2/3 of the urethral lumen. In our study, there was a significant statistical association between the etiology and patient’s age, and also between the etiology and stricture’s location and length as demonstrated by the RVUC exam.

Assessing ChatGPT responses to frequently asked patient questions in reconstructive urology.

Assessing ChatGPT responses to frequently asked patient questions in reconstructive urology.

Esophageal stricture as a complication in post operative neonates with congenital esophageal atresia with tracheoesophageal fistula

Introduction: Esophageal Atresia (EA) with Tracheoesophageal fistula (TOF) is one of the commonest congenital anomalies encountered in the pediatric surgery with commonest postoperative complication as esophageal stricture (ES) and gastroesophageal reflux disease (GERD). The aim of this study was to identify factors associated with ES formation in EA with TOF during post operative period. Materials and Methods: This cross-sectional study was carried out in pediatrics surgery department. A total 30 neonates with EA with TOF who were diagnosed clinically and radiologically were included while pure atresia cases were excluded. The distance between upper and lower esophageal pouch was noted with ruler intraoperatively. Post operative soluble contrast dye study was done to detect leaks. If no was leak present then ratio of upper and lower esophageal pouch width (UPW: LPW) was measured. During follow up, ES and GERD were diagnosed clinically and radiologically. The data was analyzed using MS-Excel and SPSS software and p value &lt; 0.5 was taken as significant. Results: The measurement of gap between upper &amp; lower pouch was &lt; 2cms and &gt;2cms in 12(40%) and 18(60%) patients respectively. The ES was found in 9(30%), GERD in 1(3.3%) and both ES and GERD in 6(20%) patients. The ratio of UPW: LPW found to be more than 1.5, equal to 1.5 and less than 1.5 in 12,2 and 1 patient respectively with ES. Dilatation for ES was required in all those with UPW: LPW &gt;1.5 which was statistically significant. The postoperative UPW:LPW ratio showed statistically significant correlation with the intraoperative gap between upper &amp; lower pouch and anastomosis under tension. Conclusion: The ES had significant correlation with gap between upper &amp; lower esophageal pouch more than 2 cm and anastomosis under tension. The ratio of UPW: LPW ≥1.5 needed dilatation for ES during follow up.

Retrograde Urethrography and Voiding Cystourethrography: Indications and Findings in Patients Presenting with Lower Urinary Tract Symptoms in Jos, North-Central Nigeria.

Urethrography is a radiologic procedure that optimizes imaging evaluation of the urethra, particularly in settings of difficulty with micturition or urethral injury. Urethrography remains the gold standard imaging tool, providing reliable and accurate diagnosis and staging of urethral stricture disease. A 10-year review of patients' archive who had retrograde urethrography or combined urethrography examinations in a peripheral facility from January 2014 to December 2023 was carried out. A total of 247 patients with complete records who met the inclusion criteria were included in this study. Demographic data, clinical indications, and the imaging findings were documented. The data were collated, entered into a computer, and processed by the use of Statistical Package for Social Sciences (SPSS), version 23, to determine frequencies (means ± standard deviations). The results are presented using frequency tables and percentages as appropriate. A P value of <0.05 was considered statistically significant with a confidence interval of 95%. The examination was normal in 89 (36.0%) patients. Urethral stricture was the commonest abnormality (44.5%) and commonly affects the bulbar urethra (70.9%). About 83.6% of the patients with stricture had 1-2 strictures while 16.4% had multiple urethral strictures. About 63.6% of patients with urethral strictures had short segment stricture, which was common at the bulbar urethra. Urethrography is an effective and cheap means of imaging the urethra mostly indicated on account of strictures and lower urinary tract symptoms. The urethral stricture is the commonest abnormal finding, which commonly affects the bulbar urethra.

Surgical Management of Anterior Urethral Stricture: A 23-year Single-Center Study.

Anterior urethral stricture is a common clinical condition in urology with significant socioeconomic impacts and is associated with high recurrence rates of and postoperative complications. However, the long-term outcome of surgical management of urethra stricture and the associated risk factors of stricture recurrence remain limited. We conducted a 23-year single-center retrospective study to evaluate the long-term surgical outcomes of anterior urethral strictures with different clinical characteristics and to study factors that contribute to stricture recurrence. A retrospective study was conducted on 145 male patients diagnosed with anterior urethral stricture, who underwent meatotomy, anastomotic urethroplasty (AU), penile skin flap urethroplasty (PFU), single-stage buccal mucosa grafting (SSU), or multistage buccal mucosa grafting (MSU) between April 2000 and August 2023. We defined 100 months as the cut-off time point to distinguish short-term and long-term follow-up. Early surgical complications were scored using the Clavien-Dindo classification at 3 months. Patient-Reported Outcome Measure (PROM) was applied to evaluate surgical success. Risk factors for wound complications were evaluated using univariable and multivariable analysis. The overall mean stricture length was 2.3 ± 1.8 cm (a range of 0.3-7.0). Stricture locations were at the meatus, fossa navicularis, penile, bulbar, and multifocal in 15, 36, 79, 9, and 6. The short-term and long-term success rate for meatotomy, AU, PFU, SSU, and MSU were 70.0%/80%, 70.4%/62.5%, 77.8%/69.2%, 100%/75%, and 81.8%/66.7%, respectively. The early complications classified as Clavien grades I, II, III, IV, and V were 39, 5, 5, 0, and 0. The late complication rate in the short-term and long-term groups were 20.3% and 30.3% (p > 0.05). The satisfaction survey showed that 74.5% (108 of 145) patients were satisfied or very satisfied with the surgical result. There was no statistically significant difference in stricture-free survival among the five surgical groups (Log rank test: χ² = 3.83, p > 0.05). The binary univariate logistic regression analysis showed that stricture symptom duration (p < 0.05) and previous urethroplasty (p < 0.05) were independent predictors of surgery failure. This long-term retrospective study on male anterior urethral stricture disease demonstrates that surgical management is an effective and functional treatment. However, the success rate of urethroplasty shows a declining trend with longer follow-up. Stricture symptom duration and previous urethroplasty carry a high risk of surgical failure.

Efficacy of the Optilume paclitaxel drug-coated balloon after urethroplasty: short-term results from a multicenter study.

The Optilume® paclitaxel drug-coated balloon (DCB) is a relatively new-to-market alternative in the management of male anterior urethral stricture disease. The pivotal trial excluded patients with a history of urethroplasty, although these strictures may be amenable to endoscopic management. Therefore, we sought to assess the efficacy of the DCB in the management of recurrent strictures following urethroplasty. A retrospective, multi-institutional review of male patients undergoing DCB dilation from 1/1/2022 to 11/1/2023 by five surgeons at four institutions was performed. Patients were stratified by history of urethroplasty; demographics, stricture characteristics, and outcomes (surgical success, time to recurrence). Success was defined as freedom from re-intervention in patients with at least 3 months of follow-up. Among the 122 cases assessed, 33 (27.0%) had previously undergone urethroplasty. Patients in the urethroplasty group were younger than those in the control group (51.6 vs 58.8 years, p = 0.022). The two groups were otherwise similar with regard to background characteristics and comorbidities. Patients in both groups had similar stricture characteristics with short bulbar strictures being the most common. When compared to the control group, those with a history of prior urethroplasty had a greater median number of interventions prior to DCB treatment (3 vs 1, p < 0.001). Postoperative cystoscopy was performed in 37 cases, with similar patency rates between groups (p > 0.999). Early success rates were similarly high in both groups (80.0% post-urethroplasty vs 88.9% control, p = 0.338), although follow-up was limited to a median of 3.5 months in the urethroplasty group and 2.9 months in the control group (p = 0.069). Despite a greater number of prior surgical interventions, patients with a history of urethroplasty achieve similarly high success rates after treatment with DCB compared to those without a history of urethroplasty.

Evaluating the impact of a urethral reconstruction fellowship on urethral stricture disease management at a regional hospital.

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.

P0089 Infra-red microspectroscopy provides quantitative assessment of fibro-inflammation in Crohn’s disease strictures and predicts post-operative recurrence

Abstract Background Quantitative assessment of fibro-inflammation in Crohn’s disease strictures remains a challenge despite its role in clinical decision making using immunomodulatory drugs or endoscopic/surgical interventions. While histology remains the gold standard, no validated histological scoring systems for Crohn’s disease strictures exist and assessment is subject to significant intra- and inter-observer variability. Fourier-transform infra-red (FTIR) microspectroscopy is a reproducible, label-free and non-destructive approach for analysing tissue biochemistry via molecular vibrations. We have previously shown accurate assessment of inflammation severity using this technique in colitis models (1). The aim of this study was to assess Crohn’s disease strictures using FTIR spectroscopy and to evaluate if tissue spectra can predict post-operative Crohn’s disease recurrence. Methods Full-thickness Crohn’s stricture resections (n=72) were obtained in paraffin and sectioned for hyperspectral imaging using the Agilent Cary 670 FPA-IR coupled with the Agilent Cary 620 microscope in transflection mode in the wavenumber region 1800–800 cm-1. Nearly 8 million spectra in total were acquired from regions of interest in each of the bowel wall layers per sample (Figure 1). Spectra was transformed to the second derivative, normalised and reduced to 25 spectra per sample prior to analysis using partial least squares discriminant analysis (PLSDA) with internal cross-validation. Adjacent tissue sections were stained with H&amp;E, Masson’s trichrome and α-smooth muscle actin. Histology was scored based on the averaged scores of three independent clinical histopathologists for inflammation, fibrosis and muscular changes. Results Tissue infra-red spectra demonstrated excellent performance defined by area under the receiver operating characteristic curve (AUC) of ≥0.9 using PLSDA to classify severe from mild inflammation and good (AUC ≥0.8) to excellent (AUC ≥0.9) performance to classify severe from mild fibrosis and muscular hyperplasia/hypertrophy. In those with complete macroscopic Crohn’s disease resection (n=51), spectra from index stricture resections demonstrated good performance (AUC ≥0.8) in discriminating between future significant endoscopic recurrence defined by Rutgeert’s score ≥ i2 (2) and excellent performance for surgical recurrence (AUC ≥0.9) defined as future surgical resection of Crohn’s recurrence. Conclusion FTIR microspectroscopy can detect biochemical differences underlying inflammation, fibrosis and muscular changes in Crohn’s strictures and provide simultaneous quantitative assessment. The biochemical tissue fingerprints demonstrate good to excellent discrimination for predicting endoscopic and surgical Crohn’s recurrence, respectively.

P0235 Intestinal Ultrasound and Its Advanced Modalities in Characterizing Strictures in Crohn's Disease

Abstract Background Crohn’s disease (CD) strictures exhibit varying levels of inflammation and chronicity. Treatment decisions are likely to improve when the predominant phenotype is known1. Intestinal ultrasound (IUS) allows transmural evaluation with potential to characterize this predominant phenotype2. Here, we evaluated whether conventional intestinal ultrasound (IUS) in combination with advanced modalities (contrast-enhanced ultrasound (CEUS) and shear-wave elastography (SWE)) is accurate in characterizing the predominant phenotype of CD strictures. Methods CD patients with a confirmed stricture at endoscopy (non-passable with the endoscope) or MRE1 were included. All patients underwent IUS prior to a small bowel segmental resection. Histology in the resection specimen was assessed in location-matched tissue sections. Following a consensus session, two pathologists blindly assessed the predominant phenotype (inflammatory (IP), chronic (CP) or mixed (MP)) in the strictures. The primary objective of the study was to find a (combination of) IUS parameter(s) to identify strictures with an IP. Results Out of 107 patients with a CD stricture, 36 were included (median IUS and surgery: 14 days). Histology revealed an inflammatory phenotype in 7/36 (20%), chronic in 16/36 (44%) and mixed in 13/36 (36%). In univariate analysis loss of wall layer stratification (WLS) (OR:7.86, p=0.029) and CEUS parameters (best performing: wash-in area under the curve (WiAUC): cut-off:38.20 dB, AUROC:0.84, p=0.011, sens:86%/spec:77%) were associated with an IP. Bowel wall thickness (BWT) (5.74 vs 7.46 mm, p=0.002) was lower and colour Doppler signal (CDS) (OR:0.14, p=0.03) and loss of WLS (OR:0.14, p=0.027) were less present in CP. The optimal BWT to determine a CP was &amp;lt;6.4 mm (AUROC: 0.83, p=0.001, sens/spec: 75%). SWE correlated inversely with hypervascularity (CEUS parameters [ρ=-0.36 to -0.47, all p&amp;lt;0.04] and CDS [ρ=-0.68, p&amp;lt;0.001]) but did not determine the predominant phenotype. In multivariate analysis, loss of WLS and WiAUC≥38.20 dB indicated an IP, whereas lower BWT and CDS≤2 indicated a CP. With these parameters, the Stricture Score Amsterdam (SSA) (Table 1) was constructed where a score &amp;gt;2 demonstrated high accuracy for an IP (AUROC:0.88, p=0.002) and a negative score (&amp;lt;0) high accuracy for a CP (AUROC:0.90, p&amp;lt;0.0001) (Figure 1). Inter-observer agreement for the score was good (ICC:0.73, p&amp;lt;0.0001). A combination of IUS and CEUS is accurate to differentiate between inflammatory and chronic strictures in CD. The SSA needs external validation and evaluating its potential as a diagnostic decision aid when choosing between surgical and available medical treatments.

Diagnostic investigation, intervention, and outcome for post-subtotal gastrectomy patients who present with jaundice.

Endoscopic retrograde cholangiopancreatography (ERCP) is a useful diagnostic and interventional tool in patients with obstructive jaundice. In patients who had subtotal gastrectomy, however, the implementation of ERCP has become more difficult. This study aims to investigate the accuracy of contrast-enhanced CT, MRI/MRCP and PET/CT in lesion localization, characterization, and extent evaluation in post-subtotal gastrectomy patients who present with obstructive jaundice. The interventional methods for biliary drainage, their success rate and patient outcome were also investigated. Electronic medical records were reviewed to identify patients hospitalized for obstructive jaundice at Peking Union Medical College Hospital, who had previously undergone subtotal gastrectomy. The clinical information, imaging and interventional examination data of those patients were retrospectively collected. Between 2018 and 2023, 36 patients with previous subtotal gastrectomy were hospitalized for ob-structive jaundice at our hospital. The majority of lesions were malignant, including 19 gastric cancer recurrence (47.5%), and 12 other malignancies (30.0%). Benign lesions included inflammatory biliary stricture, biliary stones, and IgG4-related disease. The three imaging modalities had similar performance in lesion localization and characterization, whereas PET/CT showed higher accuracy compared to MR and CT in detecting extensive disease (92.8% vs. 83.3% vs. 60.0%). Percutaneous transhepatic cholangial drainage was applied more frequently than ERCP and surgery (69.4% vs. 25.0% vs. 5.5%), and there was no significant difference concerning technical and clini-cal success rate and complication. Gastric cancer recurrence and newly-developed pancreaticobiliary malignancies were the main causes of obstructive jaundice in patients who had subtotal gastrectomy. PET/CT was superior to MRI/MRCP and contrast-enhanced CT in determining lesion extensiveness. Percutaneous transhepatic cholangial drainage (PTCD) was the preferred method for managing obstructive jaundice. Despite the effectiveness of interventions, a significant number of patients experienced short-term disease progression.

Etiology of panurethral strictures in a low socioeconomic status population.

Panurethral strictures represent the most severe form within the anterior urethral stricture spectrum, requiring more technically complex repairs and resulting in poorer outcomes compared to localized anterior urethral strictures (penile or bulbar). This abstract aims to describe the distinct characteristics of patients with panurethral strictures in a low socioeconomic status population. Patients presenting with localized anterior (penile or bulbar) or panurethral strictures at University Hospital in Newark, NJ, between 2021 and 2023 were retrospectively identified. Data were extracted from electronic medical records and analyzed statistically using IBM SPSS Software. Among the patients, 33 had localized anterior urethral strictures, and 22 had panurethral stricture disease. Hispanic and African American patients accounted for the majority of stricture cases (63.6%), including 59% of the panurethral stricture cohort. The only statistically significant factor contributing to panurethral disease was lichen sclerosis (p < 0.05). Patients with panurethral strictures had a higher incidence of inflammatory and systemic diseases such as STDs, recurrent UTIs, diabetes, and hypertension, while those with localized anterior urethral strictures showed a higher incidence of iatrogenic factors, including prior catheterizations and transurethral surgeries. However, these factors did not reach a statistical significance. Hypospadias repair was observed in 6% of localized anterior urethral stricture cases, compared to 13.6% of panurethral stricture cases. While iatrogenic causes remain the predominant contributors, inflammatory and systemic conditions, particularly lichen sclerosis, significantly influence the development of panurethral strictures. Early surgical intervention and better management of systemic diseases may prevent the progression of localized anterior urethral strictures to panurethral disease, but further studies utilizing larger number of patients may shed light on the significance of these systemic factors.

Comparison of the mechanical properties of porcine buccal mucosa and ureter and the clinical implications.

Buccal mucosal grafts have a well-established role in urology regarding the management of ureteric stricture disease. Despite its established use as a graft material there is a lack of data on the mechanical properties of buccal mucosa. We aim to compare the passive mechanical properties of porcine buccal mucosa with the ureter. Buccal mucosa (n = 20) and ureteric specimens (n = 21) were harvested from 19 domestic pigs at the time of euthanasia. Mechanical testing was performed using a uniaxial tensometer to generate stress-strain curves. From these curves, ultimate tensile strength and elastic modulus were calculated. Data was analysed, and one-way ANOVA testing was used to assess for significance variation in mechanical response due to direction of testing, and between tissue types. Porcine ureteric specimens displayed mechanical anisotropy, with a significant difference in the elastic modulus depending on the direction of testing (p = 0.005), and a higher mean ultimate tensile strength in the longitudinal (498.09kPa) compared to the transverse (263.99kPa) direction (p = 0.0005). Buccal mucosa was isotropic with no significant difference in elastic modulus or ultimate tensile strength according to direction of testing. Comparison of tissue types showed a significantly greater mean ultimate tensile strength in the longitudinal direction (p = 0.002) in ureter compared to buccal mucosa. We present the first comparison of the mechanical properties of buccal mucosa with ureter, and demonstrate significant variation in elastic modulus and ultimate tensile strength between the tissue types. These findings have important clinical implications for physiological function and in the design of alternative approaches for reconstruction in buccal mucosa grafted ureters.

Reply to Editorial Comment on "Development of a Patient-reported Outcome Measure for Patients With Ureteral Stricture Disease".

Reply to Editorial Comment on "Development of a Patient-reported Outcome Measure for Patients With Ureteral Stricture Disease".

Efficacy and Safety of Optilume Drug-Coated Balloon for Urethral Stricture Treatment: A Systematic Review and Meta-Analysis.

The Optilume drug-coated balloon (DCB) (North Plymouth, USA) is a novel treatment option for urethral stricture disease that combines mechanical dilation with localized delivery of paclitaxel, an antiproliferative drug aimed at reducing recurrence rates by inhibiting scar tissue formation. This systematic review and meta-analysis, conducted using studies published in the last 10 years up to November 2024, assessed the efficacy and safety of Optilume DCB across seven studies involving 457 patients. Key outcomes included significant reductions in symptom scores, as measured by the International Prostate Symptom Score (IPSS), and improvements in urinary flow rates (QMax). The recurrence-free rate was approximately 80.83%, suggesting that Optilume offers durable symptom relief. The complication rate, calculated as a weighted average across studies, was low at 9.5%, with most adverse events being mild and temporary, including dysuria and urinary tract infections. These findings support Optilume DCB as a promising minimally invasive alternative to standard treatments, offering durable outcomes with a favorable safety profile. Further randomized trials with longer follow-ups are recommended to confirm these benefits in diverse patient populations.

Retrograde urethrography (RUG) combined with voiding cystourethrography (VCUG) versus surgical findings in assessment of urethral strictures length

Background and objective: Retrograde urethrography (RUG) combined with voiding cystourethrography (VCUG) is the most common and preferred imaging modality for evaluating urethral strictures, despite its well-known limitations and disadvantages. In this study, we assessed the clinical relevance of RUG + VCUG, along with intraoperative assessment in measuring male urethral strictures. Method: This study was a single-center retrospective study involving 134 male patients diagnosed with urethral stricture disease. All participants underwent RUG + VCUG before the intervention, and the results were interpreted by a single radiologist. The location and length of urethral strictures were assessed. The accuracy of urethral stricture measurements obtained from combined VCUG and RUG imaging was compared to intraoperative measurements, which served as the reference standard. Urethral strictures were classified into three types: membranous and bulbomembranous, bulbar, and penile. Results: A total of 130 patients were included (38.14 ± 12.05 years) in the study. For patients with membranous and bulbar strictures, there were statistically significant differences in stricture length measurements between VCUG + RUG and surgical evaluation ( p &lt; 0.05). However, for patients with penile strictures, the differences in stricture length measurements between VCUG + RUG and surgical evaluation were not statistically significant ( p = 0.448). Conclusion: This study suggests that RUG + VCUG may underestimate urethral stricture, particularly in the membranous and bulbar regions.

HPB SO21 - Percutaneous Biliary Endoscopy for Managing Disease in Endoscopically Inaccessible Biliary Trees: A Single Unit Experience in the UK

Abstract Background Patients with a history of hepatobiliary surgery often require interventions for complications such as hepatolithiasis, recurrent disease, or anastomotic strictures. Access to the biliary tree in these, and other post-operative patients, is hindered by a diverted alimentary tract or comorbidities that preclude endoscopy or re-operation. While forms of biliary endoscopy have been used for many years in combination with ERCP, recent advances now allow for the combination of percutaneous radiological interventions with cholangioscopy. We share our early experiences and outcomes using percutaneous biliary endoscopy (PBE) to manage a challenging cohort of patients Method In our hospital trust, a multidisciplinary team consisting of Interventional Radiologists, endoscopy staff, and a Hepatobiliary Surgeon performed some of the first PBE procedures using the SpyGlass device in the UK. The biliary tree was accessed under ultrasound and fluoroscopic guidance, followed by tract dilation to admit a 12F sheath. This allowed use of the SpyGlass device, along with adjuncts such as electrohydraulic lithotripsy catheters, dilation balloon catheters, biopsy forceps, and biodegradable stents through the working channel. This combined approach enhances the rate of conclusive biopsy and benefits from both visual assessment and radiological navigation. Results To date, 9 PBE procedures have been performed on 7 individual patients. Indications have included strictured hepaticojejunostomy, hepatolithiasis, malignant and benign biliary strictures. The first two patients underwent two-stage treatment of their disease following concerns about the burden of their treatment, however procedural intent was achieved in all cases. To date, two patients have experienced complications. The first required ITU admission for inotropic support in the context of a septic shower and the second suffered cholangitis secondary to a post-procedural haemorrhage and intraductal thrombus, requiring traditional internal/external drainage. Conclusion PBE, with its adjuncts, offers a minimally invasive alterative to operative treatment, and improved conclusive biopsy rates in patients with endoscopically inaccessible bile ducts due to post-surgical anatomy or impassable strictures. With appropriate multidisciplinary collaboration, PBE could easily be adopted in most hepatobiliary centres where the required equipment is likely to be readily available

Impact of race and ethnicity on clinical outcomes and recurrence post-ureteral reconstruction.

Ureteral stricture disease (UTSD) poses significant challenges in reconstructive urology, with recent advances highlighting disparities in healthcare outcomes based on race and ethnicity. This study investigates the impact of race and ethnicity on clinical outcomes following ureteral reconstruction. We conducted a single-centre prospective analysis of 233 patients who underwent ureteral reconstruction for UTSD from 2014 to 2023. Patient demographics, clinical characteristics, surgical details and outcomes were collected. Patients were stratified by race (White vs. non-White) and ethnicity (Hispanic vs. non-Hispanic). Statistical analyses included Kruskal-Wallis, Mann-Whitney U tests, ANOVA, Kaplan-Meier analysis and multivariate logistic regression. Our cohort included 233 patients who underwent ureteroplasty with 108 (46.4%) non-White patients, and 71 (30.5%) were Hispanic. No significant differences were found in recurrence rates, complications, or stricture-free survival between racial and ethnic groups. Prior reconstructions were more prevalent among non-White patients (26.9% vs. 16.0%; p = 0.043). Unadjusted and adjusted regressions showed significant associations between non-White race (unadjusted β = 0.76, p = 0.008; adjusted β = 0.82, p = 0.008) and Hispanic ethnicity (unadjusted β = 0.70, p = 0.025; adjusted β = 0.79, p = 0.020) with increased stricture lengths. This study highlights that although recurrence and complication rates do not significantly differ by race or ethnicity, disparities exist in clinical presentations, with non-White and Hispanic patients presenting with longer stricture lengths and higher body mass index. These findings underscore the need for targeted interventions to address underlying disparities in healthcare delivery and access.

The outcome of nontransecting anastomotic urethroplasty in recurrent bulbar urethral stricture and its impact on sexual functions: A prospective observational study

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.