Stricture Rate Research Articles

Double barrelled uro-colostomy versus Ileal conduit for urinary diversion following pelvic exenteration: a single centre experience.

The ideal method for urinary diversion following total pelvic exenteration (TPE) remains unclear. This study compares the outcomes of double-barrelled uro-colostomy (DBUC) and ileal conduit (IC) in a single Australian centre. All consecutive patients who underwent pelvic exenteration with the formation of either a DBUC or an IC between 2008 and November 2022 were identified from the prospective database from the Royal Adelaide Hospital and St. Andrews Hospital. Demographic, operative characteristics, general perioperative, long-term urological and other relevant surgical complications were compared via univariate analyses. Of 135 patients undergoing exenteration, 39 patients were eligible for inclusion: 16 patients with a DBUC, and 23 patients with an IC. More patients in the DBUC group had previous radiotherapy (93.8% vs. 65.2%, P = 0.056) and flap pelvic reconstruction (93.7% vs. 45.5%, P = 0.002). The rate of ureteric stricture trended higher in the DBUC group (25.0% vs. 8.7%, P = 0.21), but in contrast, urine leak (6.3% vs. 8.7%, P>0.999), urosepsis (43.8% vs. 60.9%, P = 0.29), anastomotic leak (0.0% vs. 4.3%, P>0.999), and stomal complications requiring repair (6.3% vs. 13.0%, P = 0.63) trended lower. These differences were not statistically significant. Rates of grade III or greater complications were similar; however, no patients in the DBUC group died within 30-days or had grade IV complications requiring ICU admission compared with two deaths and one grade IV complication in the IC group. DBUC is a safe alternative to IC for urinary diversion following TPE, with potentially fewer complications. Quality of life and patient-reported outcomes are required.

Urinary symptoms after genital gender-affirming penile construction, urethral lengthening and vaginectomy.

Transgender and non-binary (TGNB) individuals are seeking penile reconstruction in greater numbers; many pursue urethral lengthening surgery with a goal of voiding while standing. Changes in urinary function and urologic complications-i.e., urethrocutaneous fistulae and urinary stricture-are common. Familiarity with presenting symptoms and management strategies for urinary complaints after genital gender-affirming surgery (GGAS) can improve patient counseling and outcomes. We will describe current gender-affirming penile construction options with urethral lengthening and review associated urinary complications that present as urinary incontinence. The incidence and impact of lower urinary tract symptoms after metoidioplasty and phalloplasty are poorly characterized due to limited post-operative follow-up. Post-phalloplasty, urethrocutaneous fistula is the most common urethral complication, ranging in incidence from 15-70%. Assessment of concomitant urethral stricture is necessary. No standard technique exists for management of these fistula or strictures. Metoidioplasty studies report lower rates of stricture and fistula, 2% and 9% respectively. Other common voiding complaints include dribbling, urethral diverticula and vaginal remnants. History and physical exam in the post-GGAS evaluation require understanding of prior surgeries and attempted reconstructive efforts; adjuncts to physical exam include uroflowmetry, retrograde urethrography, voiding cysto-urethrogram, cystoscopy, and MRI. Following gender-affirming penile construction, TGNB patients may experience a host of urinary symptoms and complications that impact quality of life. Due to anatomic differences, symptoms require tailored evaluation which can be done by urologists in an affirming environment.

Endoscopically injectable and self-crosslinkable hydrogel-mediated stem cell transplantation for alleviating esophageal stricture after endoscopic submucosal dissection.

Esophageal stricture after extensive endoscopic submucosal dissection impairs the quality of life of patients with superficial esophageal carcinoma. Beyond the limitations of conventional treatments including endoscopic balloon dilatation and the application of oral/topical corticosteroids, several cell therapies have been recently attempted. However, such methods are still limited in clinical situations and existing setups, and the efficacies are less in some cases since the transplanted cells hardly remain at the resection site for a long time due to swallowing and peristalsis of the esophagus. Thus, a cell transplantation platform directly applicable with clinically established equipment and enabling stable retention of transplanted cells can be a promising therapeutic option for better clinical outcomes. Inspired by ascidians that rapidly self-regenerate, this study demonstrates endoscopically injectable and self-crosslinkable hyaluronate that allows both endoscopic injection in a liquid state and self-crosslinking as an in situ-forming scaffold for stem cell therapy. The pre-gel solution may compatibly be applied with endoscopic tubes and needles of small diameters, based on the improved injectability compared to the previously reported endoscopically injectable hydrogel system. The hydrogel can be formed via self-crosslinking under in vivo oxidative environment, while also exhibiting superior biocompatibility. Finally, the mixture containing adipose-derived stem cells and the hydrogel can significantly alleviate esophageal stricture after endoscopic submucosal dissection (75% of circumference, 5 cm in length) in a porcine model through paracrine effects of the stem cell in the hydrogel, which modulate regenerative processes. The stricture rates on Day 21 were 79.5% ± 2.0%, 62.8% ± 1.7%, and 37.9% ± 2.9% in the control, stem cell only, and stem cell-hydrogel groups, respectively (p < 0.05). Therefore, this endoscopically injectable hydrogel-based therapeutic cell delivery system can serve as a promising platform for cell therapies in various clinically relevant situations.

Delayed primary repair in 100 infants with isolated long-gap esophageal atresia: A nationwide analysis of children’s hospitals

BackgroundThis study aimed to evaluate the contemporary surgical management of long-gap esophageal atresia, a rare and challenging problem managed by pediatric general surgeons. MethodsA retrospective review of the Pediatric Health Information System database for infants who underwent neonatal gastrostomy, followed by surgical reconstruction for long-gap esophageal atresia (2014–2021). Patients with birthweight less than 1.5 kg and those who received neonatal cardiac surgery were excluded. Outcomes were analyzed, including the need for further procedures, length of stay, and mortality. ResultsOf 1,346 infants who underwent repair across 47 major children’s hospitals, 100 (7%) met the inclusion criteria for long-gap esophageal atresia. Cardiac anomalies were identified in 43% of patients. The median age at repair was 87 days (interquartile range, 62–133). Ten percent of patients had a planned or unplanned reoperation ≤30 days after index surgery, and 4% underwent reoperation at >30 days. The median time to reoperation was 9 days (interquartile range, 7–60). Mortality during index admission was 5%, and the median hospital length of stay was 143 days (interquartile range, 101–192). Length of stay was significantly longer in patients with cardiac anomalies (cardiac: 179 days, non-cardiac: 125 days; P < .001), and 52% of patients required at least 1 postoperative dilation. The median time to the first dilation was 70 days (interquartile range, 42–173). ConclusionThis large multicenter study highlights the challenges of infants with long-gap esophageal atresia but suggests a high rate of successful delayed primary reconstruction. Hospitalizations are prolonged, and anastomotic stricture rates remain high. These data are useful for pediatric surgeons in counseling families on surgical repair strategy, timing, and postoperative outcomes.

MP65-09 STENT FREE RATES IN CUTANEOUS URETEROSTOMY URINARY DIVERSION AFTER RADICAL CYSTECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP65-09 STENT FREE RATES IN CUTANEOUS URETEROSTOMY URINARY DIVERSION AFTER RADICAL CYSTECTOMY Parth Thakker, Justin Refugia, Corey Able, Randy Casals, and Matvey Tsivian Parth ThakkerParth Thakker More articles by this author , Justin RefugiaJustin Refugia More articles by this author , Corey AbleCorey Able More articles by this author , Randy CasalsRandy Casals More articles by this author , and Matvey TsivianMatvey Tsivian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003323.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Cutaneous ureterostomy (CU) urinary diversion after radical cystectomy has historically been relegated to highly comorbid patients due to presumed rates of stenosis and subsequent drainage tube dependence. Historically, rates of stricture as high as 70% have been reported and many leave patients entirely stent dependent for fear of stenosis related complications. Though a variety of techniques have been developed to obviate need for prolonged stenting, CU remains an uncommonly performed method of urinary diversion. We believe that rates of tube dependence in single-stoma CU are lower than anticipated and thus presents a viable option for all patients undergoing radical cystectomy. METHODS: A retrospective review of patients having undergone radical cystectomy with single-stoma cutaneous ureterostomy from August 2020 to August 2022 by a single-surgeon, was performed. Demographic data and presence of stent, nephrostomy, or nephroureteral catheter was observed at last follow up. The primary outcome was “stent-free survival” incorporating all modalities of tube-dependent urinary drainage. Kaplan-Meier analysis was performed to determine stent-free survival at 6 and 12 months. RESULTS: A total of 26 patients underwent radical cystectomy with cutaneous ureterostomy during this time period with a median age of 73 years (IQR: 64-78). Median body mass index was 25.45 (IQR: 22.75-28.7). At 6 months 76.6% of patients were tubeless and at 12 months 82.4% of patients were free of urinary drainage tubes. Four (15.4%) patients had continued tube dependence due to disease progression rather than CU stenosis. One (3.8%) patient expressed a strong desire to keep their stents. CONCLUSIONS: Single-stoma CU is a viable option for patients undergoing radical cystectomy with excellent tube-free rates at 1 year. Cutaneous ureterostomy should be considered a viable option for urinary diversion. Longer follow up is needed to assess durability of tube-free rates long term. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e894 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Parth Thakker More articles by this author Justin Refugia More articles by this author Corey Able More articles by this author Randy Casals More articles by this author Matvey Tsivian More articles by this author Expand All Advertisement PDF downloadLoading ...

Does mitomycin-C and triamcinolone injection therapy during optical urethrotomy able to reduce the recurrence of urethral stricture? A comparison study.

Background: Male urethral stricture is one of the common diseases. Stricture disease may lead to severe complications which badly affect the quality of life like urinary tract infection, vesical stones, urethrocutaneous fistulas, sepsis, and finally renal impairment. Due to its high recurrence rates, it is one of the most complex and challenging issues in urological practice. The aim of the study is to evaluate the effect of intralesional mitomycin-C and triamcinolone after direct visualized internal urethrotomy on the recurrence of urethral stricture. Method and patient: An observational comparative study that was conducted between September 2019 and October 2021. It included 34 male participants with urethral stricture. Twelve participants were in group A in whom participants underwent direct visualized internal urethrotomy with no adjuvant treatment, 11 participants were in group B who underwent direct visualized internal urethrotomy with mitomycin-C injection and another 11 patients underwent direct visualized internal urethrotomy with triamcinolone injection were in group C. Patients were selected from outpatient clinic. Patients with idiopathic causes of stricture, traumatic non-instrumental or post-urethroplasty stricture, recurrent stricture and stricture more than 15 mm in length were excluded from the study. Follow up was done at 3, 6 and 12 months post-operatively. Result: In this study, only one patient among 11 who received mitomycin-C injection (9.1%) had recurrence while 2 out of 11 patients who received triamcinolone (18.2%) had recurrence. Six out of 12 patients (50%) who undergone direct visualized internal urethrotomy only had recurrence. Adjuvant therapy decreased the recurrence rates, and the results were statistically significant. No correlation between stricture recurrence time and the type of adjuvant therapy used was found. Relationship between recurrence rate of stricture and various other variables such as age of the patient, length of stricture, stricture site and etiology were not observed in the study as the p-value was greater than 0.05. Conclusions: Intralesional injection of either Mitomycin-C or Triamcinolone reduces the recurrence rate of urethral strictures with statistically significant results.

MP65-17 LENGTH OF URETER RESECTED AT TIME OF URINARY DIVERSION IS ASSOCIATED WITH URETERAL STRICTURE RATE

You have accessJournal of UrologyCME1 Apr 2023MP65-17 LENGTH OF URETER RESECTED AT TIME OF URINARY DIVERSION IS ASSOCIATED WITH URETERAL STRICTURE RATE Arighno Das, Tudor Borza, Daniel Shapiro, E. Jason Abel, David Jarrard, and Kyle Richards Arighno DasArighno Das More articles by this author , Tudor BorzaTudor Borza More articles by this author , Daniel ShapiroDaniel Shapiro More articles by this author , E. Jason AbelE. Jason Abel More articles by this author , David JarrardDavid Jarrard More articles by this author , and Kyle RichardsKyle Richards More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003323.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Benign ureterointestinal anastomotic (UIA) strictures are a morbid complication following cystectomy with urinary diversion. Data from renal transplantation literature suggests that shorter ureters may result in fewer anastomotic strictures due to improved vascularization of the re-implanted segment. We evaluated whether length of distal ureteral resection may impact rates of UIA strictures in cystectomy patients. METHODS: A database of patients who underwent cystectomy with urinary diversion from 2015 to 2022 was analyzed. All cases were performed by a single surgeon to control for variations in surgical technique. Distal ureteral resections were routinely sent for final pathology. Length of this resection was collected from pathology reports. Benign UIA strictures were confirmed with renal scintigraphy, antegrade nephrostogram, or endoscopic evaluation. Relationship between stricture formation and clinical parameters were assessed using T-tests, Chi-squared tests, and multivariable analysis. RESULTS: A total of 362 patients underwent cystectomy with urinary diversion from 2015 to 2022. Of the cohort, 35 (9.6%) patients developed UIA strictures. Median time to stricture formation was 12.5 months (IQR 4-30). Of the 724 ureteral anastomoses among the 362 patients, 40 anastomoses developed benign strictures (6%). Median distal ureteral length resected was significantly longer among anastomosis that did not form a stricture (2.2 cm vs 1.65 cm, p=0.044, Table). Strictures more commonly formed on the left side, although this did not reach significance (65% vs 35%, p=0.051). Multivariable logistic regression adjusting for surgical approach, prior radiation, ureteral side, and urinary diversion type demonstrated longer distal ureteral resections were associated with a significantly lower risk of ipsilateral stricture formation (OR 0.74, 95% CI 0.58-0.94). CONCLUSIONS: The etiology of benign UIA strictures is multifactorial. Vascular compromise is a critical hypothesis. We found that longer distal ureteral resections (and thus shorter ureters) were associated with a significantly lower risk of stricture formation in cystectomy patients, consistent with renal transplantation data. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e898 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Arighno Das More articles by this author Tudor Borza More articles by this author Daniel Shapiro More articles by this author E. Jason Abel More articles by this author David Jarrard More articles by this author Kyle Richards More articles by this author Expand All Advertisement PDF downloadLoading ...

MP42-10 SELF-EXPANDING LARGE CALIBER URETERAL STENTS FOR TREATMENT OF IDIOPATHIC URETERAL STRICTURE

You have accessJournal of UrologyCME1 Apr 2023MP42-10 SELF-EXPANDING LARGE CALIBER URETERAL STENTS FOR TREATMENT OF IDIOPATHIC URETERAL STRICTURE Hyun Soo Lee, Sun Tae Ahn, Wonku Hwang, Seon Beom Jo, Jong Wook Kim, Mi Mi Oh, Hong Seok Park, and Du Geon Moon Hyun Soo LeeHyun Soo Lee More articles by this author , Sun Tae AhnSun Tae Ahn More articles by this author , Wonku HwangWonku Hwang More articles by this author , Seon Beom JoSeon Beom Jo More articles by this author , Jong Wook KimJong Wook Kim More articles by this author , Mi Mi OhMi Mi Oh More articles by this author , Hong Seok ParkHong Seok Park More articles by this author , and Du Geon MoonDu Geon Moon More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003280.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Treatment for the idiopathic ureteral stricture has not yet been established. Recently, efficacy of self-expanding large caliber stent (Allium, Allium LTD, Israel) for ureteral stricture related to surgery, radiation or malignancy was reported. This study aims to investigate the effect of Allium stent on idiopathic ureteral stricture. METHODS: From July 2018 and January 2022, 54 patients with 58 renal units were underwent ureteroscopic balloon dilation and placement of Allium stent. All the patients showed hydronephrosis before the stenotic lesion and pain. In all the patients, we used, 12 cm or 20cm length of self-expanding Allium ureteral stent and inserted retrogradely with intraoperative x-ray guidance after dilation of the stricture (Figure 1). The primary outcome was immediate improvement in pain and improvement in hydronephrosis through ultrasound examination at 1 month after the procedure. And the secondary outcome was stricture resolution rates following stent removal. RESULTS: Patients and ureteral stricture characteristics were summarized in Table 1. Of 54 patients, 20cm stent was inserted in 47 patients and 12cm stent was inserted in 7 patients. After median follow-up period of 16.5 months, 39.7 % (23/58) of stents were kept in situ. Median indwelling time was 10months (range 1-37) and stent migration was observed in 8 cases (13.8%). All the patients were immediately free of pain after the procedure, and through ultrasound examination, improvement of hydronephrosis was confirmed in 53 out of 58 renal units. Among the 42 renal units which stent removal was performed, 13 renal units (31.0%) recurred stricture. Logistic analysis showed that stricture length was a significant predicting factor for stent failure (HR 2.75, 95% CI 1.58, 4.79, p<0.01) CONCLUSIONS: Self-expanding allium ureteral stenting showed efficacy in relieving pain and improving hydronephrosis in idiopathic ureter stricture with minimal risk of complication. Overall success rate after stent removal was associated with preoperative stricture lengths. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e570 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hyun Soo Lee More articles by this author Sun Tae Ahn More articles by this author Wonku Hwang More articles by this author Seon Beom Jo More articles by this author Jong Wook Kim More articles by this author Mi Mi Oh More articles by this author Hong Seok Park More articles by this author Du Geon Moon More articles by this author Expand All Advertisement PDF downloadLoading ...

MP73-06 OUTCOMES OF SALVAGE CRYOTHERAPY FOR BIOCHEMICAL RECURRENCE FOLLOWING PRIMARY RADIOTHERAPY IN THE MANAGEMENT OF PROSTATE CANCER - 14-YEARS SINGLE INSTITUTION EXPERIENCE

You have accessJournal of UrologyCME1 Apr 2023MP73-06 OUTCOMES OF SALVAGE CRYOTHERAPY FOR BIOCHEMICAL RECURRENCE FOLLOWING PRIMARY RADIOTHERAPY IN THE MANAGEMENT OF PROSTATE CANCER - 14-YEARS SINGLE INSTITUTION EXPERIENCE Gregory Mansour, Andrew Wang, and Robert Given Gregory MansourGregory Mansour More articles by this author , Andrew WangAndrew Wang More articles by this author , and Robert GivenRobert Given More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003341.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Salvage cryotherapy of the prostate remains a treatment option for biochemical recurrence (BCR) following either radiotherapy or other local ablative therapies of prostate cancer. Previous studies have assessed long-term oncologic results to include overall disease survival in addition to freedom from starting ADT. We aim to assess oncologic outcomes in addition to de novo stricture, fistula, urinary incontinence, and erectile dysfunction rates. METHODS: We retrospectively reviewed all men who underwent salvage cryotherapy following external beam radiation therapy (EBRT), proton beam therapy, primary cryotherapy, and brachytherapy at our institution from 2005 through 2019. Functional and oncologic outcomes were assessed. Biochemical recurrence-free survival was defined based on a combination of the Phoenix and Astro criteria and analyzed using Kaplan-Meier statistics. RESULTS: Of the total 85 patients included, 71 had primary EBRT, 9 had brachytherapy, 3 had combined EBRT and brachytherapy, and 2 had proton beam therapy. All patients had negative staging workups prior to salvage therapy. Recto-urethral fistulas occurred in 2 patients (2.3%), 21 patients (24.4%) developed urethral strictures, and 23 patients (26.7%) reported de novo incontinence requiring pads. 5- year overall biochemical free survival was 49%. A total of 53% of subjects had biochemical recurrence with a mean time of 39 months after salvage treatment. Overall cancer specific survival was 86% and metastasis free survival was 77.9%. There was not a statistically significant correlation identified between pretreatment PSA and timing to BCR R2=0.05 p=0.129. One patient did not have a PSA response after salvage cryotherapy and went on to develop metastatic disease. CONCLUSIONS: Salvage cryotherapy remains one of the few potentially curative interventions following primary radiotherapy for prostate cancer. This study highlights the necessity for patient counseling given the side effect profile. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1036 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gregory Mansour More articles by this author Andrew Wang More articles by this author Robert Given More articles by this author Expand All Advertisement PDF downloadLoading ...

Comparison of Functional Outcomes of Intestinal Flaps Vs Tubed Fasciocutaneous Flaps for Circumferential Pharyngoesophageal Defects-an Indian Perspective.

Pharyngolaryngoesophageal (PLO) reconstruction is a complex and technically demanding procedure. The reconstructive surgeon's concerns include avoiding fistula and stricture formation, as well as restoring normal speech and swallowing. A retrospective observational study with circumferential pharyngo-laryngo-oesophagal defects with aims and objectives of evaluation and comparison of the long-term functional outcomes like speech and swallowing along with the complications of fistula and stricture in two groups of JFF and FC flaps from the data is collected from electronic medical records of Tata Memorial Hospital, Mumbai, from January 2011 to May 2020. A total of 67 patients (52 JFF and 15 fasciocutaneous flaps) were operated on in last 9 years in our institute. The difference in fistula rates and stricture rates between the two groups was not significant (p= 0.98 and 0.947). The difference in 100% oral diet between the two groups was significant (p= 0.019). The difference in speech rehabilitation between the two groups was significant (p= 0.024). The intestinal tubes and fasciocutaneous tubes have comparable outcomes with regard to fistula and stricture formation. Speech outcomes in the form of the ability to have functional speech and voice quality were significantly better with skin-lined tubes. Swallowing outcomes were much better with intestinal tubes, along with early oral alimentation.

Prevention of stricture after semi-circumferential and whole circumferential esophageal endoscopic resection

: Stricture formation after esophageal endoscopic resection (ER) worsens a patient’s quality of life because it causes dysphagia and requires multiple endoscopic dilations. Numerous methods are available to prevent esophageal stricture formation after ER. For noncircumferential resections, much evidence indicates local steroid injection is the best choice and is therefore widely used in clinical practice. However, local steroid injection alone is insufficient to prevent stricture of whole circumferential resections. Accordingly, we should select oral steroid administration or combination therapy (oral steroid administration + local steroid injection) for such extensive resections. However, the stricture rate is significantly higher compared with noncircumferential resections despite these prevention methods. Steroid therapies, including local injection and oral administration, have the advantages of high effectiveness and low cost. However, concerns include the risk of steroid-related complications such as immunosuppression, diabetes onset/exacerbation, and fragility of the esophageal wall. Also, favorable outcomes of modified steroid methods such as local triamcinolone acetonide (TA) injection together with a polyglycolic acid sheet (PGA), TA-soaked PGA sheet together with a fully covered metal stent, and TA filling method have been reported. Innovative methods include tissue engineering approaches such as cell sheet transplantation and autologous mucosal transplantation. Despite the promise of these methods, further studies are required to establish their efficacies before widespread use in clinical practice.

India Ink Tattooing of Ureteroenteric Anastomoses

While upper tract access through the insensate conduit following urinary diversion takes less time and incurs fewer costs than percutaneous kidney access does for the treatment of ureter and kidney pathology, endoscopic ureteroenteric anastomoses (UEA) identification can be difficult. We injected India Ink into the bowel mucosa near the UEA during ileal conduit diversion (IC) to determine the safety and feasibility of ink tattooing. Patients undergoing IC were prospectively randomized to receive ink or normal saline (NS) injections. The injections were placed 1 cm from UEA in a triangular configuration, and loopogram exams and looposcopy were performed to identify reflux (UR), UEA, the tattooing site and strictures in 10 and 11 patients randomized with respect to ink and NS injections, respectively. Ink patients were older (72 vs. 61 years old, p = 0.04) and had a higher Charlson Comorbidity Index (5 vs. 2, p = 0.01). Looposcopy was performed in three ink and four NS patients. Visualization of UEA was achieved in 100% of the ink and 75% of the NS patients (p = 0.26). The ink ureteroenteric anastomotic stricture (UEAS) rate was higher (N = 3 vs. N = 1) and six patients vs. one patients underwent surgery, respectively, for UEAS (p = 0.31). The study was halted early due to safety concerns. Our pilot study demonstrates that ink can be well visualized following injection near UEA during IC. However, the ink cohort had more UEAS than previously cited in the literature and our prior institutional UEAS rate of 6%. While this study sample is small, the higher incidence of UEAS after ink injection led us to question the utility and safety of ink injection following IC.

Examination of Clinical, Endoscopy and One-Year Follow-Up Findings of Children with Accidental Ingestion of Caustic Substances Admitted to Shahid Sadoughi Hospital (2016-2019)

Introduction: Accidental ingestion of caustic substances can cause serious damage to the digestive system. This study was conducted with the aim of investigating the incidence of esophageal stricture within one year after accidental ingestion of caustic substances and its relationship with the first endoscopic findings in children.&#x0D; Methods: The present study was a retrospective and cross-sectional study that has been conducted for 3 years on children with accidental ingestion of caustic substances referred to Shahid Sadoughi Hospital in Yazd City (August 2015-2015). Demographic information, type and amount of ingested material, initial symptoms, initial endoscopic findings and degree of esophageal tissue burn were recorded and the patients were followed up for one year. Finally, the data were analyzed by SPSS version 22 software.&#x0D; Results: In this study, 55 children were evaluated, their average age was 3.19 years. Participants consisted of 23 (41.8%) girls and 32 (58.2%) boys. Children had ingested pipe openers chemicals (30.9%), bleach liquid (29.1%) and hydrochloric acid (12.7%), respectively. Initial endoscopic findings were normal in 45.5% of children, and the most damage was grade IIb and IIa. The incidence rate of esophageal stricture in month later was 47.3%, and in the year later, the total incidence of stricture and GOO was 27.3% (16.4% of esophageal stricture and 7.3% of stricture and GOO).&#x0D; Conclusion: The present study showed that esophageal injury following the accidental ingestion of caustic substances is common in children, and the presence of symptoms in the patients at the beginning of the visit can be associated with higher grade injuries, and the occurrence of stricture is more common after severe injuries.

The Outcome and Safety in Laparoscopic Common Bile Duct Exploration with Primary Suture versus T-Tube Drainage: A Meta-Analysis.

Sometimes, after choledochotomy, the common bile duct is closed with T-tube drainage for several weeks to prevent postoperative complications such as biliary fistula and stricture. But there has been controversy over the advantages of primary suture versus T-tube drainage. The purpose of our meta-analysis in laparoscopic common bile duct exploration is to appraise the efficacy and safety of T-tube drainage and primary suture. The literatures were searched by Web of Science, PubMed, Cochrane Library, OVID, and EMBASE between the year January 1, 2001 and February 28, 2021. Meta-analysis was performed by Stata 12. Fourteen studies with 1,549 patients (827 vs. 722) were included in our study. The primary suture group had significant lesser operative time (P ≤ 0.001), postoperative hospital stay (P ≤ 0.001), hospital expenses (P ≤ 0.001), intraoperative bleeding (P=0.001), and postoperative complications (P=0.006) than the T-tube drainage group. In postoperative bleeding (P=0.289), bile leakage (P=0.326), and bile duct stricture (P=0.750), there was no statistical difference. In the primary suture group, using single-arm synthesis, the bile leakage rate and the bile duct stricture rate were 0.07 vs. 0.04 and 0.00 vs. 0.00 in interrupted suture and continuous suture groups. The bile duct stricture rate was same in both groups, and the bile leakage rate was lower in the interrupted suture group. But the difference was not significant. The primary suture group had several advantages, including lesser operative time, postoperative complications, intraoperative bleeding, postoperative hospital stay, and hospital expenses. In bile leakage and bile duct stricture, the difference between the two groups was not significant. In the primary suture group, interrupted suture and continuous suture groups had similar bile leakage rate and bile duct stricture rate.

One-stage repair of proximal hypospadias by in situ tubularization of the transverse preputial island flap

PurposeThis study aimed to compare the efficacy of modified transverse preputial island flap (TPIF) repair with the traditional TPIF procedure and Byar’s two-stage procedure in proximal hypospadias repair, especially in the postoperative urethral stricture incidence rates.Materials and methodsPatients admitted for proximal hypospadias treated with modified TPIF repair, the traditional TPIF procedure, or Byar’s two-stage procedure at our institution from 2017 to 2021 were identified, and the incidence of postoperative complications among them was compared.ResultsIn total, 142 patients were included (modified TPIF group, 43; traditional TPIF group, 37; and Byar’s two-stage group, 62). The length of the neourethra was 4.21 ± 0.63 cm in the modified TPIF group, 4.18 ± 0.71 cm in the traditional TPIF group, and 4.20 ± 0.68 cm in the Byar’s two-stage group. The rate of urethral stricture in the modified TPIF group (two cases, 4.65%) was significantly lower than that in the traditional TPIF group (four cases, 10.81%) (P = 0.008). Seven (16.28%) cases of urethrocutaneous fistula occurred in the modified TPIF group, six (16.22%) in the traditional TPIF group, and eight (12.90%) in the two-stage group. Additionally, one case (2.33%) of urethral diverticulum occurred in the modified TPIF group, one (2.70%) in the traditional TPIF group, and three (4.84%) in Byar’s two-stage group.ConclusionsModified TPIF repair can ensure a wedge anastomosis between the proximal urethral meatus and the neourethra, provide support and blood supply for the neourethra. Furthermore, it extended the urethral plate width at the anastomosis and urethral meatus, effectively reducing the incidence of urethral strictures.

Risk Factors of Anastomosis Stricture After Esophagectomy and the Impact of Anastomosis Technique

BackgroundAnastomosis complications after esophagectomy are related to postoperative survival and quality of life. This is a retrospective observational study to identify risk factors for anastomotic stricture after esophageal cancer surgery and the effect of different anastomosis techniques on stricture development. MethodsThis study included 737 patients who underwent esophagectomy for esophageal cancer that used stomach conduits. Four types of anastomoses were used: manual sewing (n = 221, 30%), circular stapling (n = 172, 23%), hybrid linear stapling with a 45-mm stapler (HLS; n = 155, 21%), and triangular linear stapling with 60-mm staplers (TLS; n = 189, 26%). Multivariate analysis was performed to evaluate the risk factors for stricture. ResultsStrictures that required endoscopic dilatation within 1 year after surgery occurred in 105 patients (14%), and 13% of the strictures were related to leakage. Multivariate analysis revealed that chronic obstructive pulmonary disease (hazard ratio [HR] 1.726, P = .017), leakage (HR 2.502, P = .015), and anastomosis techniques other than TLS (manual sewing: HR 9.588; circular stapling: HR 6.516; HLS HR 5.462, all P < .001) were significant risk factors for stricture. TLS significantly reduced the stricture rate (3.2%) compared with other techniques (manual sewing: 22.2%; circular stapling:, 14.5%; HLS: 16.1%; P < .001). Stricture rate was lower in the TLS group in patients without leakage (P < .001); however, the effect disappeared with leakage. ConclusionsAnastomosis stricture occurred in 14% of esophagectomy patients. Chronic obstructive pulmonary disease, leakage, and anastomosis technique are risk factors for stricture. A large anastomosis area with the TLS technique using 60-mm length linear staplers prevented stricture, especially when leakage was not observed.

Comparison of statins with steroids and botulinum toxin A in the prevention of benign strictures after esophageal endoscopic submucosal dissection: a retrospective cohort study.

Preventing benign strictures following esophageal endoscopic submucosal dissection (ESD) remains difficult, and finding a safe, effective, and simple management method is vital. We previously reported that rosuvastatin significantly reduced the incidence and severity of strictures in a rabbit model of esophageal stricture. Accordingly, in this study, we compared the effects of statins, steroids, and botulinum toxin A (BTX-A) on stricture prevention after ESD involving more than three-fourths of the luminal circumference. Of the 1019 ESD cases treated between January 2015 and December 2020, 246 met the inclusion criteria, with 21 cases excluded due to loss to follow-up, tumor recurrence, death, or need for additional surgery, radiotherapy, and/or chemotherapy. Of the 225 included cases, 145 received no intervention, while the remaining 80 were treated: 16 with oral steroids, 20 with topical triamcinolone acetonide (TA) injection, 21 with topical BTX-A injection, and 23 with statins. The occurrence stricture rate in the statins group (17.4%, 4/23) was significantly lower than in the non-intervention (75.2%, 109/145, P = 0.000), oral steroids (56.3%, 9/16, P = 0.011) and TA injection (50%, 10/20, P = 0.023) groups, but comparable to in the BTX-A injection (38.1%, 8/21, P = 0.124) group. The dysphagia score was lower in the statin than non-intervention group (P = 0.000). Although there was no significant difference in the number of required dilations between groups, the maximum number of dilations in the statins group was only six. Statins may be a potential treatment to prevent esophageal strictures after extensive ESD; however, clinical trials should be conducted to validate this.

Outcome of Urethral Stricture Managed by Different Surgical Techniques

Aim: To compare the outcome of urethral stricture managed by different surgical techniques. Place and Duration: This Study was conducted at Lahore General Hospital, Lahore in the duration from May, 2022 to October, 2022. Methods: This randomized controlled trial was conducted on 60 patients divided equally in two groups. Both groups were assessed for maximum urinary flow 6 months after surgery, cause of the stricture, site of the stricture and success rate was assessed between both variables. T-test and Chi Square test with P &lt; 0.05 as statistically significant were used to assess various outcomes between both groups. Results: The mean age in urethroplasty group was 44.43±10.618 years while in endoscopic urethrotomy group the mean age was 48.23±11.790. Urethroplasty was significantly successful in 80% patients whereas endoscopic urethrotomy was successful in 43.3% patients (P = 0.003). Conclusion: Urethroplasty is a safe and effective technique for treatment of urethral stricture. Keywords: Urethral stricture, Urethroplasty, Endoscopic urethrotomy, Efficacy

Hybrid argon plasma coagulation in Barrett's esophagus: a systematic review and meta-analysis.

Patients with Barrett's esophagus are at increased risk of developing esophageal adenocarcinoma. Endoscopic therapies aim to eradicate dysplastic and metaplastic tissues. Hybrid argon plasma coagulation (hybrid-APC) utilizes submucosal fluid injection to create a protective cushion prior to ablation that shields the submucosa from injury. We performed a pooled meta-analysis to evaluate the safety and efficacy of hybrid-APC. We conducted a systematic search of major electronic databases in April 2022. Studies that included patients with dysplastic and non-dysplastic Barrett's esophagus undergoing treatment with hybrid-APC were eligible for inclusion. Outcome measures included complete remission of intestinal metaplasia (CR-IM), stricture formation, serious adverse events, and number of sessions necessary to achieve CR-IM. Overall pooled CR-IM rate for patients undergoing hybrid-APC was 90.8% (95% confidence interval [CI], 0.872-0.939; I2=0%). Pooled stricture rate was 2.0% (95% CI, 0.005-0.042; I2=0%). Overall serious adverse event rate was 2.7% (95% CI, 0.007-0.055; I2=0%). Results of the current meta-analysis suggest that hybrid-APC is associated with high rates of CR-IM and a favorable safety profile. Interpretation of these results is limited by the inclusion of retrospective cohort and case series data. Randomized controlled trials that standardize treatment and outcome evaluation protocols are necessary to understand how this treatment option is comparable to the current standards of care.

Comparation between the Bricker ileal conduit vs double-barrelled wet colostomy after pelvic exenteration for gynaecological malignancies

BackgroundAfter exhausting other therapeutic options, pelvic exenteration is performed in patients who suffer from relapsed gynaecologic tumours, with most of them requiring some sort of urinary diversion. Material and methodsThe main objective of this study was to assess the short- and medium/long-term urinary complications associated with the Bricker ileal conduit versus double-barrelled wet colostomy after performing a pelvic exenteration for gynaecologic malignancies. ResultsA total of 61 pelvic exenterations were identified between November 2010 and April 2022; 29 Bricker ileal conduits and 20 double-barrelled wet colostomies were included in the urinary diversion analysis. Regarding the specific short-term urinary complications, no differences were found in the rate of urinary leakage (3 vs 0 %; p = 1), urostomy complications (7 vs 0 %; p = 0.51), acute renal failure (10 vs 20 %; p = 0.24) or urinary infection (0 vs 5 %; p = 0.41). Up to 69 % of patients with Bricker ileal conduits and 65 % of double-barrelled wet colostomies (p = 0.76) presented specific medium/long-term urinary complications. No differences in the rates of pyelonephritis (59 vs 53 %; p = 0.71), urinary fistula (0 vs 12 %; p = 0.13), ureteral stricture (10 vs 6 %; p = 1), conduit failure and reconstruction (7 vs 0 %; p = 0.53), renal failure (38 vs 29 %; p = 0.56) or electrolyte disorders (24 vs 18 %; p = 0.72) were found. ConclusionsThere are no significant differences in the rate of complications between double-barrelled wet colostomy and the Bricker ileal conduit. The long-term complications related to urinary diversion remained high regardless of the type of technique. In this context, the double-barrelled wet colostomy presents advantages such as the single stoma placement and the simplicity of the technique.