Stricture Disease Research Articles

DOP85 Crohn's Disease Strictures Respond to Drug Treatment and Treat-to-Target Intense Combination Therapy is More Effective than Standard Anti-TNF Therapy. Two year results of the STRIDENT Randomised Controlled Trial.

Abstract Background The randomised STRIDENT (Stricture Definition and Treatment) trial showed that Crohn’s disease symptomatic strictures are responsive to anti-TNF therapy with most patients clinically improved after 12 months treatment with adalimumab +/- thiopurine. Treat to target intensification resulted in greater stricture morphology improvement. We present here 2 year (from study entry) follow up to assess response durability and risk of surgery. Methods Patients with symptomatic Crohn’s disease strictures and associated inflammation (elevated faecal calprotectin and CRP) were assessed with imaging (intestinal ultrasound and MRI) and ileo-colonoscopy. The Obstructive Symptom Score (OSS) was used for clinical assessment. Patients were randomised 2:1 to high dose adalimumab induction (160mg weekly for 4 weeks) followed by 40mg fortnightly plus thiopurine, with adalimumab dose increase at 4 and/or 8 months if evidence of ongoing inflammation, versus standard dose adalimumab monotherapy. The primary endpoint was improved OSS at 12 months. Patient interview was conducted at 24 months, assessing drug treatment, symptoms, need for endoscopic therapy, hospitalisation and surgery. Results In the initial 12 months study 52 patients were randomised to the intensive and 25 to the standard treatment arm. 64/77 (83%) patients recorded an outcome at 12 months (13/77 (17%) withdrawn: 8 surgery, 5 other) 74/77 (96.1%) patients were followed up at a mean of 25.3 (IQR 24.4-26.3) months. Of these, 59 (79.7%) remained on adalimumab, 10 (13.5%) had switched to another biologic and 5 (6.7%) had ceased biologic therapy. For patients who were on adalimumab at 12 months the risk of surgery by 24 months was 15%. Of patients on adalimumab 40mg fortnightly at 12 months, 12/48 (25%) had been dose escalated by 24 months. Endoscopic balloon dilatation, hospitalisation or surgery was required in 6 (8.1%), 14 (18.9%) and 13 (17.5%) respectively; rates were not different between the standard and intensive treatment groups (P = 0.982). Median time to intestinal resection was 12.2 (IQR 6.9-18.6) months. Clinical responders at 12 months, compared to non-responders, had a reduced likelihood of surgery at 24 months (9% vs 42%, P=0.003). Conclusion Clinical response to adalimumab for structuring Crohn’s disease is durable in a majority of patients, with most patients remaining on adalimumab and avoiding surgery at two years. Rates of surgery were not different between the standard and intensive therapy arms. Clinical response to adalimumab at 12 months is an important predictor of future surgical risk.

P749 Crohn’s disease stricture response and resolution with adalimumab therapy demonstrated with intestinal ultrasound. The STRIDENT randomised trial

Abstract Background Transmural healing is a treatment goal in the management of Crohn’s disease, and intestinal ultrasound (IUS) is potentially a sensitive, non-invasive and reproducible means to assess the response to treatment. Methods The STRIDENT (Stricture Definition and Treatment) study was a randomised controlled trial of standard dose monotherapy adalimumab versus intensive high-dose adalimumab combined with a thiopurine. Crohn’s disease patients with symptomatic intestinal strictures were randomised 2:1 to high dose adalimumab induction (160mg weekly for 4 weeks) with 40mg fortnightly maintenance plus thiopurine, with possible dose escalation at 4 and 8 months, versus standard dose adalimumab monotherapy. The primary endpoint was clinical response, defined as a reduction in the Obstructive Symptom Score (OSS) of ≥1, at 12 months. IUS was performed at baseline, 4, 8 and 12 months. IUS endpoints included stricture resolution (normalisation of pre-stenotic dilation (<2.5cm); reduced stricture bowel wall thickness (BWT ≥25% reduction); reduced colour doppler blood flow (inflammation, Limberg score ≤1) and normalisation of BWT (≤3mm). Patients with good quality baseline IUS and IUS-visible strictures were included for analysis. Results 77 patients underwent therapy randomisation. Of 63 patients with IUS-visible strictures 43 (68%) were in the intensive arm. Primary outcome was achieved by 32 (74%) patients in the intensive and 14 (70%) in the standard arms. Stricture resolution was seen in 1/5 non-responders and 18/45 responders. Median BWT reduced from 6.4mm (IQR 5.2-7.3mm) at baseline to 4.9mm (IQR 3-6mm) at 12 months (P<0.001). Clinical responders had significant reduction in median BWT from 6.0mm (IQR 4.5-7.1) at baseline to 4.3mm (IQR 3-5.7) at 12 months (P<0.001). There was no significant reduction in BWT at 4, 8 or 12 months in non-responders (P=0.26, P=0.29, P=0.26 respectively). BWT >3mm at 12 months occurred more often in non-responders than responders (P<0.05). Stricture resolution was seen in 13/36 in the intensive arm and 6/14 standard arm (P=0.75). The intensive arm had significant reduction in median BWT from 6.6mm (IQR 5.5-7.4mm) at baseline to 5.1mm (IQR 3-6.4mm) at 12 months (P<0.001). There was no significant reduction in BWT at 4, 8 or 12 months in the standard arm (P=0.75, P=0.42, P=0.09 respectively). There was no significant difference in BWT>3mm between trial arms at 12 months (P=1). Conclusion Stricture resolution and bowel wall thickness normalisation were demonstrated on intestinal ultrasound in stricturing Crohn’s disease patients treated with adalimumab therapy. Adalimumab therapy is associated with clinical improvement, and transmural improvement and healing, in patients with Crohn’s disease strictures.

P581 Early biological therapy within the first 12 months after diagnosis leads to higher clinical, endoscopic, and transmural remission in Crohn’s disease: European multicentre study with a propensity-score matched analysis

Abstract Background Transmural healing (TH) is emerging as a potential treatment target for Crohn′s Disease (CD). While post-hoc analyses of RCTs and observational studies have shown that early introduction of biological therapy leads to higher rates of clinical (CR) and endoscopic remission (ER), no data is available for TH. Our goal was to assess the impact of early biologic introduction (defined as <12 months since diagnosis) in CR, ER, and TH rates. Methods Multicentre retrospective study including 5 European centres. Patients with CD with a baseline (±3 months) either computed tomography enterography (CTE) or magnetic resonance enterography (MRE) with signs of active disease before starting biologics were included. We assessed CR (PRO2<8), ER (SES-CD<3 and no ulcers), and TH (complete normalization of MRE) at 12±3 months following the introduction of biologics. All radiological examinations were read locally after a consensus meeting to list and define clinically relevant lesions and outcomes. Multivariate logistic regression with propensity-score matching also adjusted for previous biologic use was conducted (propensity-score covariates: gender, age at diagnosis, disease location, disease behavior, perianal disease, extra-intestinal manifestations, smoking history, and previous surgery). Results We included 168 patients (51% females), with a median age at diagnosis of 25 years old (IQR 19-34). Median follow-up time after treatment initiation was 73 (IQR 42-98) months and median disease duration was 120 (IQR 76-237) months. Most patients (93%) had ileal involvement (L1 or L3) and an inflammatory phenotype (50%). Overall, 79% were bio naïve and of those 46% were started on early biological treatment. Most patients were started on anti-TNF (89%), 10% on ustekinumab, and 1% on vedolizumab; 58% were on combination therapy (table 1). CR was achieved in 76% (119/157), ER in 52% (64/124), and TH in 32% (30/95). In the multivariate logistic regression model, early initiation of biological treatment was significantly associated with increased probability of achieving CR (OR 4.3, 95%CI 1.6-11.5, p=0.003), ER (OR 2.9, 95%CI 1.2-7.1, p=0.02) and TH (OR 2.7, 95%CI 1.002-7.1, p=0.049). The presence of a stricture in endoscopy was a negative independent factor to predict ER (table 2) and the presence of a stricture and extensive disease in cross-sectional imaging were negative independent factors to predict TH (table 3). Conclusion Introducing biological treatment within the first 12 months after diagnosis was associated with an increased probability of achieving CR, ER, and TH. The presence of a stricture both in endoscopy and in cross-sectional imaging and the radiological extension of the disease may limit the achievement of ER and TH, respectively.

DOP12 Validation of radiomics features on MR enterography characterizing inflammation and fibrosis in stricturing Crohn’s disease

Abstract Background MR enterography (MRE) accurately detects Crohn’s disease (CD) strictures, yet its ability to differentiate inflammatory from fibrostenotic components within a CD stricture is limited. Artificial intelligence in cross sectional imaging, termed radiomics, is a quantitative image extraction analysis technology creating an opportunity to enhance characterization of strictures on routine MRE exams. We present a study on machine-reader evaluation of MRE to distinguish inflammation and fibrosis in CD strictures via quantitative radiomic features and compare radiomics performance to central radiologist scoring of MRE. Methods In this retrospective single center study 51 patients (n=34 for discovery; n=17 for validation) had confirmed stricturing CD (using CONSTRICT criteria) on MRE. Surgical histopathology scoring of specimens within 15 weeks of MRE exam (range 0-100, scores ≥70 =severe) was used as the reference standard for both inflammation and fibrosis. An expert abdominal radiologist blinded to clinical and histopathologic results provided a global visual analog scale (VAS, 0-100) assessment of stricture inflammation and fibrosis. 2164 3D radiomic features were extracted from the stricture regions on MRE, from which the most relevant feature subsets were identified via cross-validated machine learning analysis in the discovery cohort for differentiating between severe vs mild inflammation and fibrosis. Radiomic features and VAS scores were evaluated against pathology-defined inflammation and fibrosis in the validation cohort. Results Clinical variables including sex, age, Montreal classification and stricture type across discovery and validation groups can be found in Table 1. The median time from MRE to surgical resection was 7.1 90-15) weeks. 43% of strictures in the overall cohort were classified as severe for inflammation and 43% had severe fibrosis. Two distinct sets of radiomic features capturing textural heterogeneity (patterns, local entropy) within strictures were significantly associated with severe inflammation or severe fibrosis (p<0.01). For inflammation, AUC for discovery and validation were 0.69 and 0.67, respectively (Figure 1). For fibrosis, AUC for discovery and validation were 0.83 and 0.77, respectively (Figure 2). The radiologist VAS had an AUC of 0.71 for identifying inflammation and AUC 0.46 for identifying fibrosis. Combining radiomic features and radiologist VAS had no significant impact on predictor performance. Conclusion Radiomic analysis may support the identification of fibrosis, but not inflammation in stricturing CD compared to radiological visual assessment. This tool may offer a novel way to stratify patients for future anti-fibrotic therapies.

DOP32 Crohn’s disease stricture matrisome analysis reveals the anti-fibrotic activity of milk-fat globule-epidermal growth factor 8 (MFGE8)

Abstract Background Intestinal fibrosis is considered an inevitable consequence of chronic inflammatory bowel disease (IBD), leading to stricture formation and need for surgery. During the process of fibrogenesis, extracellular matrix (ECM) components critically regulate the function of mesenchymal cells. We characterized the composition and function of the ECM in fibrostenosing Crohn’s disease (CD) and control tissues. Methods Decellularized full thickness intestinal tissue platforms were tested using three different protocols and ECM composition in different tissue phenotypes was explored by proteomics and validated by quantitative polymerase chain reaction (qPCR) and immunohistochemistry. Primary human intestinal myofibroblasts (HIMF) treated with Milk Fat Globule-Epidermal growth factor 8 (MFGE8) were evaluated regarding mechanism of their anti-fibrotic response, and the action of MFGE8 was tested in experimental intestinal fibrosis. Results We established and validated an optimal decellularization protocol for intestinal IBD tissues. Matrisome analysis revealed elevated MFGE8 expression in CD strictured tissue (CDs), which was confirmed at the mRNA and protein levels. Treatment with MFGE8 inhibited ECM production in normal control (NL) HIMF but not CDs HIMF. Next generation sequencing (NGS) uncovered functionally relevant integrin-mediated signaling pathways, and blockade of integrin αvβ5 and focal adhesion kinase rendered HIMF non-responsive to MFGE8. MFGE8 prevented and reversed experimental intestinal fibrosis in vitro and in vivo. Conclusion MFGE8 displays anti-fibrotic effects, and its administration may represent a future therapeutic approach for prevention of IBD-induced intestinal strictures.

P311 Reliability of computed tomography enterography for evaluation of stricturing Crohn’s disease: Development of a Crohn’s disease stricture index

Abstract Background Computed tomography enterography (CTE) is frequently used to assess stricturing Crohn’s disease (CD). However, the reliability of CTE items used for assessment has not been established and there is no validated radiologic stricture severity index. Methods We conducted a retrospective study of 43 patients with symptomatic, terminal ileal stricturing CD. Four radiologists assessed a comprehensive list of pre-defined radiologic items potentially associated with stricture severity in 48 CTE scans in two separate rounds in random order. Reliability was quantified using the intraclass correlation coefficient (ICC). Items with at least moderate (ICC≥0.41) inter-rater reliability that were correlated with a visual analogue scale of overall stricture severity were candidate items for the development of a CTE stricture index. Results Inter-rater reliability was almost perfect for assessment of luminal diameter of pre-stenotic dilation (ICC 0.817 [95% confidence interval 0.703, 0.878]), substantial for stricture length (ICC 0.628 [0.419, 0.797]), and moderate for stricture wall thickness (0.482 [0.330, 0.601]). Intra-rater reliability was almost perfect (ICC ≥ 0.850) for all three items. A stricture severity index was derived and was well calibrated (optimism-adjusted calibration slope = 1.009), with scores calculated as the sum of stricture length (cm) + luminal diameter of pre-stenotic dilation (mm) + 5 x stricture wall thickness (mm). Conclusion Stricture length, prestenotic dilation, and stricture wall thickness can be reliably assessed, and are component items for a novel CTE stricture index (CTE-SI) of stricture severity for CD-related terminal ileal strictures. Additional external index validation for clinical and research contexts is required.

Imaging in urethral stricture disease: an educational review of current techniques with a focus on MRI.

Urethral stricture disease refers to narrowing of the urethral lumen obstructing the flow of urine. Urethral strictures can significantly impact daily life due to incontinence, incomplete emptying, hesitancy, and increased risk of urinary tract infections. Imaging is central to the evaluation of suspected urethral stricture, as assessment of stricture length and severity is crucial for guidance of surgical management. The currently employed modalities include radiography, chiefly retrograde urethrography (RUG) and voiding cystourethrography (VCUG); magnetic resonance urethrography (MRU); and sonourethrography (SUG). MRU has become a recent focus of research as it provides high spatial resolution, multiplanar capacity, and soft tissue type differentiation for evaluation of periurethral compartments and concurrent soft tissue defects. The protocol for MRU has evolved over the years to now include dynamic micturition imaging and image reconstruction options. In this review, we discuss each of the imaging modalities used in the diagnosis and evaluation of urethral stricture and provide an overview of literature on MRU over the last decade, including suggested indications that have not yet been incorporated into current guidelines. We delineate scenarios where special diagnostic imaging beyond radiography is beneficial, providing examples from our practice and description of our techniques for each modality.

Comparative effect of intraurethral clobetasol and tacrolimus in lichen sclerosus-associated urethral stricture disease.

Management of urethral stricture related to lichen sclerosus (LS) is now gradually changing from surgical to nonsurgical due to availability of anti-inflammatory agents such as corticosteroids and calcineurin inhibitors. We determined the clinical impact of these agents in such patients on outpatient department basis in terms of improvement in symptoms on International Prostate Symptom Score (IPSS), external skin appearance, and maximum urinary flow rate (Qmax). Eighty patients of meatal stenosis and penile urethral stricture with histopathologically proven LS were divided into two groups, and clinical and predetermined parameters such as Qmax, IPSS, and changes in external appearance were compared between these groups after 3 months of topical and intraurethral application of clobetasol and tacrolimus with self-calibration. A significant intragroup difference was noted in IPSS (P < 0.001) as well as Qmax (P < 0.001); postintervention intergroup difference in IPSS was not significant (P = 0.94) and however postintervention intergroup difference in Qmax was significant in favor of clobetasol (P = 0.007). A significantly increased number of additional procedures were done in the group receiving intraurethral tacrolimus (P = 0.0473) with significantly less number of skin complication in the group with topically applied clobetasol (P = 0.003). Though both clobetasol and tacrolimus, improved symptom score, Qmax and local external appearance yet topical and intra-urethral clobetasol application via urethral self calibration seems to be better option for lichen sclerosus related urethral stricture in terms cost and local complications.

The Burden of Urologic Diseases in a Tertiary Hospital in South-eastern Nigeria: A Three-Year Review.

Urological diseases are an integral part of the surgical burden of diseases. There are national, regional, and global variations. Characterisation of the burden of disease in this specialty is important for the registry and in allocation of the already scarce resource in this sub-region. This study was aimed at characterising the burden of urological diseases in our teaching hospital as a means towards addressing the gap between resources and urological needs. It was a retrospective study of new patients seen over 3 years from January 2019 to December 2021 at the urology clinics of Alex-Ekwueme Federal University Teaching Hospital Abakaliki. Data collected included sex, age, and diagnosis. Data analysis was done using SPSS version 26. A total of 2893 patients were available for analysis, of which 2777 (96%) were male patients whereas 116 (4%) were female patients with a male-to-female ratio of 23.9:1. The mean age of the patients was 58.11 ± 16.76 years. The common presentations were benign prostatic enlargement (BPE) 1515 (52.4%), cancer of the prostate (CAP) 349 (12.1%), urethral stricture disease 268 (9.3%), and urinary tract infection (UTI) 192 (6.6%). In men, the three most common diagnoses were prostate-related diseases 1864 (67.1%), urethral stricture disease 268 (9.70%), and UTI 170 (6.1%), whereas, in women, urolithiasis, urinary tract infection, and hydronephrosis accounted for 50 (43.1%), 22 (19%), and 20 (17.2%), respectively. BPE, CAP, and urethral stricture disease were the most common presentations in men whereas urolithiasis, UTI, and hydronephrosis were common in women. This knowledge can be used to channel hospital resources appropriately.

Advances in reconstructive urology: A review of the 2022 literature

Reconstructive urology encompasses a broad spectrum of lower and upper urinary tract diseases. A recent society of genitourinary reconstructive mission statement emphasized the desire to promote and support research in the growing fields of tissue engineering, device design, patient-reported outcomes, and validated measurement tools for urethral stricture disease. The purpose of this article was to identify and highlight the high-impact recent literature published within reconstructive urology during the past year. Original research, systematic reviews, and videos from the Gold Journal, BJUI, World Journal of Urology International, SIU Journal, Neurourology Urodynamics, Journal of Urology, and European Urology were included.

Aetiopathogenesis of urethral stricture disease in a tertiary hospital in Southern Nigeria

Background: The urethra provides passage for urine in both sexes and additionally for ejaculation in males. Urethral stricture disease (USD), results in the narrowing of the urethra due to spongiofibrosis. Understanding the pathology of this disease is important to treatment. This study aims to evaluate the aetiology, pathology and pathogenesis of USD at the University of Port Harcourt Teaching Hospital.Methods: This was a 6-year retrospective study conducted on all patients with features of USD who presented to the University of Port Harcourt Teaching Hospital UPTH. Ethical approval was sought and obtained from the hospital’s ethical committee. Data were obtained from ward admission, theatre, and discharge records. The information gotten included the age of the patient, aetiologic agent, site of stricture, number of strictures, length of stricture and complications present at the presentation. The data retrieved was analysed and categorical data were presented in the form of frequencies and percentages using tables. Continuous variables were presented as means and standard deviation. Results were presented in tables and charts.Results: The mean age from this study was 44.1±16.7 years. The commonest site of USD was bulbar with 74 (67.27%) patients. The commonest cause of urethral stricture was iatrogenic (41 patients).Conclusions: Strictures are commonest amongst middle-aged men. The commonest site of urethral stricture disease is the bulbar region because of its unique anatomy. Iatrogenic strictures are the commonest cause of urethra stricture disease.

Management of urethral stricture disease in a tertiary hospital in southern Nigeria

Background: Urethral Stricture Disease (USD) refers to a narrowed segment of the anterior urethra due to a process of fibrosis and cicatrisation of the urethral mucosa and surrounding spongiosis tissue (“spongiofibrosis”). Management of USD is challenging. This study describes our experiences in the management of USD. Materials and Methods: This is a six-year retrospective study conducted at the University of Port Harcourt Teaching Hospital. Ethical approval for the study was sought and gotten from the hospital’s ethical committee. The information gotten included history, duration of symptoms, examination findings, age of the patient, stage of disease, intraoperative findings, and post-operative complications. The data from the folders were collected and evaluated. Frequencies, percentages, the mean and standard deviation were used to summarize the data as appropriate. Results: A hospital prevalence of 461/100,000. The mean age ±SD of the patients was 44.1 ±16.7. The 31 to 40 years old age group had the highest frequency of 46 (29.87%). Patients with a primary level of education had the highest frequency of 56 (50.9%). Most patients were artisans. Most (67.27%) of the strictures were located at the bulbar urethra. The most common procedure for treating USD was a Direct Vision Internal Urethrotomy (DVIU). The most common complication was a recurrence. Conclusion: Patients with urethral stricture disease present late for treatment, the commonest form of treatment was DVIU. The treatment with the best outcome was anastomotic urethroplasty. The commonest complication was a recurrence.

Management of urethral stricture disease in a tertiary hospital in southern Nigeria

Management of urethral stricture disease in a tertiary hospital in southern Nigeria

Functional outcomes after prostate cancer treatment: A comparison between single and multiple modalities

Prostate cancer is a widely common and treatable disease, and functional outcomes can greatly affect survivor quality of life. A retrospective review of the SEER-Medicare database was performed to identify patients who underwent prostate cancer treatment between January 1, 2004 and December 31, 2013 and review the rates of diagnosis and treatment of common functional side effects of surgery, radiation, or a combination of the 2 and perform a comparison of the outcomes. A total of 67,527 patients were included in the analysis. Radiation therapy (RT)-only compared to radical prostatectomy (RP)-only had lower rates of diagnosis of erectile dysfunction (30.4%, 95% CI 29.9%–30.9% vs. 56.1%, 95% CI 55.1%–57.04%, P < 0.0001), UI (29.7%, 95% CI 29.0%–30.3% vs. 44.5%, 95% CI 43.3%–45.6%, P < 0.0001), but higher rates of urethral stricture disease (8.44%, 95% CI 8.1%–8.8% vs. 5.35%, 95% CI 4.9%–5.9%, P < 0.0001), cystitis (33.1% 95% CI 32.4%–33.7% vs. 20.3%, 95% CI 19.2%–21.4%, P < 0.0001), and proctitis (14.7%, 95% CI 14.3%–15.1& vs. 2.75%, 95% CI 2.3%–3.3%, P < 0.0001). Compared to either single modality, the RP-then-RT group had higher incontinence medication use (12.0% 95% CI 10.8%–13.2% vs. 9.8%, 95% CI 9.5%–10.1% for RT-only and 8.3%, 95% CI 7.8%–8.8% for RP-only, P < 0.0001), overall incontinence therapy (18.5%, 95%CI 17.1%–20.0% vs. 10.2%, 95%CI 9.9%–10.5% for RT-only and 14.9%, 95% CI 14.3%–15.5% for RP-only, P < 0.0001), and stricture therapy (12.7%, 95% CI 11.5%–13.9% vs. 8.2%, 95% CI 8.0%–8.5% for RT-only and 9.1% 95% CI 8.6%–9.6% for RP-only, P < 0.0001). The RT-then-RP group had higher rates of stricture (25.4% compared to 8.2% for RT-only, 9.1% for RP-only, and 12.7% for RP-then-RT) and fistula (1.0% compared to 0.07% for RT-only, 0.18% for RP-only, and 0.092% for RP-then-RT) treatment than all the other groups. Multimodality therapy is generally associated with higher treatments rates for conditions such as erectile dysfunction , incontinence, urethral stricture disease , irritative cystitis and proctitis in patients older than 65. Radiation therapy followed by prostatectomy is associated with significantly worse functional outcomes. Patients undergoing or anticipating undergoing multimodality therapy for prostate cancer should be counseled regarding the possibility of increased risk of declining functional outcomes.

Burden of Prolonged Urinary Catheter Use after Urinary Retention in a Tertiary Hospital, South-South Nigeria

Background: Urinary retention is a worldwide health problem mostly noted in elderly men who may have benign prostatic hyperplasia (BPH), cancer of the prostate (Cap), urethral stricture disease or bladder tumour. It has a negative impact on the quality of life (QOL) of the sufferer as well as national or global economy. Urethral catheterization is used to relief the retention and suprapubic cystostomy where the urethral route fails or it’s contraindicated. Complications have been reported especially when catheters are worn for prolonged periods of time. The aim of this work was to study the burden of prolonged use of catheters after urinary retention. Patients and Method: The study was conducted in March 2021 and lasted for four (4) weeks to prevent data duplication since our patients change their catheters once in 4 weeks. A questionnaire was designed and completed by all patients after informed consent was obtained. Data collected were analyzed using statistical package for social science (SPSS) version 20.0 and results used for discussion. Results: Eighty two (82) patients with a mean age of 63.12±14.67 years were studied. Aetiology of urinary retention was BPH, Cap, and Urethral stricture in 58.5%, 19.5% and 23.0% respectively. More patients were in their 7th and 8th decades of life. Most patients had indwelling urethral catheter (65.9%), average duration of catheter use was 21.26 months. There was no statistical significant difference in the mean duration between those who used SPC and Urethral catheter (P= .411).Ninety-eight (98.7%) of patients had complications and 22% of them reported more than five (5) complications. Qol correlated poorly with those who had sexual issues due to prolonged catheter use. The estimated annual cost for catheter change was between N1.5million and N2.0 million in our facility. Conclusion: Prolonged catheter use is a source of concern to patients and poses serious health-related and financial burden to them.

Single-balloon Enteroscopy for Evaluation of Small Bowel Crohn Disease Strictures: Peripheral Blood Lymphocytes As a Risk Factor for Strictures.

Few reports have focused on single-balloon enteroscopy (SBE) for evaluation of small bowel Crohn disease (CD) strictures. The aim of this study was to analyze the relationships between peripheral blood inflammatory markers and small bowel CD strictures observed by SBE. CD patients who underwent SBE between January 2016 and December 2020 were enrolled. The clinical characteristics and peripheral blood inflammatory markers were collected and analyzed to screen for predictive factors significantly associated with small bowel CD strictures. A total of 221 CD patients underwent SBE. The lymphocyte (LC) counts in peripheral blood were significantly lower in the active group (n=178) than in the inactive group (n=43) according to the simple endoscopic score for CD (SES-CD), P =0.011, and was correlated with the SES-CD ( r =-0.134, P =0.047). The LC levels were significantly lower in the stricture group (n=116) than in the nonstricture group (n=105) based on whether small bowel strictures developed, P =0.000, and LC was a risk factor for strictures in the multivariate analysis [hazard ratio (HR), 2.332; 95% CI, 1.102-4.937; P =0.027]. In the subgroup analysis, LC levels notably decreased after stricture aggravation ( P =0.000). Forty-seven patients who underwent small bowel resection underwent SBE at 6 to 12 months after surgery. The LC level was significantly lower in the postoperative patients with strictures ( P =0.025), and LC (HR, 4.444; 95% CI, 1.265-15.617; P =0.020) was a risk of postoperative strictures by univariate analysis, but the age at diagnosis (HR, 6.462; 95% CI, 1.272-22.560; P =0.022) was an independent risk factor by multivariate analysis. Peripheral blood LC levels were correlated with SES-CD and gradually decreased as the intestinal stricture increased in small bowel CD patients. The LC level was also significantly lower in the postoperative CD patients with strictures. The level of LC was a risk factor for small bowel strictures. These results suggest that peripheral blood LC could be a novel marker of small bowel CD strictures to guide CD diagnosis and therapy.

Reaching Consensus for Comprehensive Outcome Measurement After Urethral Stricture Surgery: Development of Study Protocol for Stricture-Fecta Criteria.

Urethral stricture disease is a very heterogeneous condition where different urethral segments can be involved as a result of diverse etiologies which come with variable prognosis. The surgical management of urethral strictures, and in particular urethroplasties can result in very diverse outcomes on many levels and, currently, there is absolutely no consensus about what should and what should not be considered a "success" after urethral surgery. In the wake of well-established quality criteria in urologic oncology, such as tri- or pentafecta outcomes, and given the lack of agreement on meaningful outcomes after urethral surgery, we aim to introduce our study protocol as the first step of a multistep research endeavor to reach consensus on comprehensive urethroplasty outcomes within a novel conceptual framework: the "stricture-fecta criteria". The development of stricture-fecta will be based on a Delphi consensus involving some of worldwide most influencing reconstructive urologists.

Non-Transecting Urethroplasty for Bulbar Urethral Strictures—Narrative Review and Treatment Algorithm

The bulbar urethra is the most common site of stricture disease for which urethroplasty remains standard of care. A decrease in trauma as an etiology in the developed world and concerns regarding sexual dysfunction related to transection of the corpus spongiosum have placed a renewed emphasis on non-transecting urethroplasty techniques. Here, we present our surgical algorithm with emphasis on non-transecting techniques for bulbar urethral stricture disease and review the current state of literature comparing transecting to non-transecting approaches in order to provide guidance to practitioners on patient selection, counseling, and technique.

Factors Affecting Recurrence Rate of Urethral Stricture Following Internal Urethrotomy

Background: Urethral stricture (post-scarring contraction in the urethral mucosa) is among the most challenging clinical conditions in urology. In Pakistan, Urethral stricture is a high-volume disease and constitutes 4-5% of urology workload (majority of them being in the 3rd to 5th decade of life). Different urethral strictures have different management option depending upon site, size and number of recurrences. OIU is indicated for urethral stricture for small (1.5 cm) bulbar and membranous urethral stricture. However, recurrence of strictures after OIU is quite common (4 to 5%). It has been proposed that duration and size of catheter after OIU effects the recurrence rate. The foremost management choice is internal urethrotomy, but recurrences are common, and many believe that the duration and size of catheterization post internal urethrotomy may affect the recurrence rate.&#x0D; Objective: To determine the factors affecting recurrence rates of urethral stricture after internal urethrotomy.&#x0D; Methodology: It was Quasi Experimental Study conducted in Urology ward of Dr. Ziauddin University Hospital, Karachi from 10th March 2020 to 31 december 2021. Total 60 patients were included; all of the patients were divided into four equal groups. All the patients were followed quarterly for 12 months and data was recorded for urinary flow, retention, burning sensation during urination. UFM, Cystoscopy and urethrogram were done once indicated. Symptomatic patients or patients with UFM 15ml/sec were checked for recurrence followed by cystoscopy if needed. The data analysis was obtained using SPSS v. 21.0.&#x0D; Results: The mean age of the sample stood at 27 (SD ± 4) years (range: 20 to 40) years were enrolled in the study. Urethral stricture disease recurred cumulatively in 24 (40%) patients within 12 months. Mean duration of catheterization was 8.71 ± 1.1 and 2.97 ± 0.91 days in patients with and without recurrences, respectively (p=0.001). Catheter dwell times for ≥7 days was associated with increased recurrence (p=0.039). Of the patients with recurrent strictures, increased catheter diameter was also associated with higher recurrence rates (p=0.041).&#x0D; Conclusion: After careful consideration, it can be concluded that longer catheter in-dwell time and greater catheter diameter lead to a greater probability of stricture recurrence and hence the indwell time should be limited to ≤ 3 days and the catheter size chosen to be no more than 16Fr.

A modified biodegradable mesh ureteral stent for treating ureteral stricture disease

Ureteral stricture disease (USD) is a common urologic condition. Patients with ureteral stricture disease may suffer from ipsilateral flank pain, nausea, urinary calculi, infection, and impaired renal function. The treatments of USD include surgery, followed by implantation of the ureteral stent to aid the drainage of the urine. The traditional ureteral stent may sometimes cause urological infection, encrustation, and discomfort. To decrease the complication of the ureteral stent, we modified the structure and material based on the traditional ureteral stent. The traditional nondegradable Double-J shape tubular ureteral stent was turned into the biodegradable mesh ureteral stent. The modified mesh ureteral stent and Double-J ureteral stent were inserted into the ureters of the USD animals, respectively. The results of the gross morphology, serology, urinalysis, histology, microstructure, et al. demonstrated that modified mesh ureteral stent has a favorable ability in supporting the ureter and has no effect on cell proliferation, migration, apoptosis, and cell cycle of the human uroepithelial cells. The mesh ureteral stent could relieve ureter obstruction and can be slowly biodegraded after 3-5 months of implantation without the need for a second surgery to remove the stent. Compared to the Double-J ureteral stent, the modified mesh ureteral stent has a lower rate of urinary tract infection and less encrustation. It is expected to be an alternative treatment approach for USD. However, due to the limited number of animals and clinical data, further study focused on the application value in clinical practice are essential. Statement of significanceThis study demonstrates:1. A modified biodegradable mesh ureteral stent;2. Without the need for a second surgery to remove the stent;3. A lower rate of urinary tract infection and less encrustation than a double-J ureteral stent;4. An alternative treatment approach for USD.