Submucosal Tissue Research Articles

Procedural outcomes of a novel underwater injection endoscopic mucosal resection technique for colorectal polyps ≥10 mm (with video).

Background and Aims It is uncertain whether underwater EMR (U-EMR) enables resection of the submucosal tissue with sufficient margins for T1 colorectal cancer (T1-CRC) because U-EMR forgoes submucosal injection. Therefore, we developed a novel 'underwater injection EMR (UI-EMR)' method that combines submucosal injection with U-EMR to obtain adequate vertical margin (VM). Patients and methods We retrospectively analyzed procedure-related outcomes of 135 consecutive lesions from patients who underwent UI-EMR for ≥10 mm, non-pedunculated colorectal polyps (median lesion size; 15 mm). The outcomes included en bloc, R0, RX, R1 resection rates and adverse events. Additionally, the VM distance of seven T1-CRCs was evaluated. Results En bloc resection was achieved in 127 lesions (94.1%). R0 and RX resection were observed in 92 (68.2%) and 42 lesions (31.1%), respectively, while R1 resection was seen in only one lesion (0.7%). We identified two lesions (1.5%) with adverse events, which were delayed bleeding. In T1-CRCs, all seven cases had free VMs, and the median VM distance was 1140 µm (range, 731-1570 µm). Conclusions UI-EMR safely demonstrated high success rates for en bloc resection, and potentially ensures sufficient VM. This technique might become an option, particularly for relatively small lesions concerning for T1-CRC and deserve further study.

Characteristics of gastric cancers developed more than 10 years after eradication of Helicobacter pylori.

Helicobacter pylori (H pylori) eradication is expected to effectively prevent gastric cancer (GC). However, GC cases may occur even longer than 10 years after H pylori eradication (L10AE). Moreover, the associated factors and characteristics are unknown. In this retrospective, single-center study conducted between 2017 and 2022, patients with GC diagnosed after H pylori eradication were enrolled and categorized into groups according to whether they were shorter than 10 years after H pylori eradication (S10AE) or L10AE. Patients were also categorized according to the depth of cancer invasion. Clinical data, pathological data, and risk factors were analyzed using logistic regression. Clinicopathological characteristics of GC diagnosed at L10AE and those invading the submucosal tissue or deeper (SMD) were investigated. In total, 202 cases of GC occurring after H pylori eradication were identified. Comparison of 158 S10AE and 44 L10AE GC cases revealed a significantly longer surveillance interval (SI) in L10AE cases (median: 2.0 vs 1.0 years, P = .01). Comparison of 150 intramucosal and 52 SMD GC cases revealed that L10AE GC cases were significantly more frequent amongst the SMD cases (18.0% vs 32.7%, P = .03). Pathologically, undifferentiated and mixed types were significantly more frequent in GC cases with SMD invasion (P < .001). Multivariate analysis revealed that L10AE was significantly related to GC cases with SMD invasion (odds ratio, 2.45; 95% confidence interval, 1.15-5.11; P = .019). SI was significantly longer in GC that developed at L10AE than at S10AE. In addition, GC with SMD invasion was more frequently detected in L10AE than in S10AE. Our data indicated that SI should not be groundlessly extended in patients at L10AE.

Endoscopic polidocanol foam sclerobanding for treatment of internal hemorrhoids: A novel outpatient procedure.

In the study, we comment on the article by Qu et al. Internal hemorrhoids are the most common anorectal disorders worldwide with bleeding, prolapse, and difficulty in defecation. Endoscopic rubber band ligation (ERBL) is a safe, convenient, quick, and economical outpatient procedure. The main goal of ERBL is to alleviate prolapse, but the high incidence of recurrence and post-procedural pain are of clinical concern. Polidocanol foam as a local hemostatic and anesthetic agent could reduce the rates of post-procedural pain and bleeding. Endoscopic polidocanol foam sclerobanding (EFSB) is a novel approach that could lift the mucosa for easy ligation and promote increased scarring in the submucosal tissue which translates into long-term relief from prolapse recurrence and reduced 24-h post-procedural pain. The study by Qu et al is a novel multi-center prospective randomized study to compare ERBL and EFSB in patients with grades II and III internal hemorrhoids with one-year follow-up. Results showed that EFSB is a novel therapy for internal hemorrhoids, but future studies with a larger sample, multiple treatment sessions, and long-term follow-up are required to confirm these findings.

Congenital Appendiceal Atresia: An Extremely Rare Disorder Presenting with Acute Abdomen

Abstract Introduction/Objective Congenital malformations of the appendix are extremely rare and difficult to diagnose preoperatively. One of those anomalies include congenital appendiceal atresia (CAA) which mimics acute appendicitis and is usually ignored in the differentials of acute abdomen. Herein, we present a case study of congenital appendiceal atresia associated with periappendicitis. Methods/Case Report A 62-year-old female with past history of diverticulitis presented with complaints of crampy, diffuse and progressive lower abdominal pain and nausea for two days. She denied fevers, chills or change in bowel movements. Physical examination revealed vitally stable patient with soft, non-distended and tender abdomen in bilateral lower quadrants, worse on the right side and showing positive rebound test. Her complete blood count and chemistry were within normal limits. A computerized tomography arterial portography (CTAP) scan with contrast demonstrated inflammatory stranding around the appendix without abscess, concerning for acute appendicitis. She then underwent laparoscopic appendectomy. Grossly, the appendix consisted of a cylindrical portion of yellow-pink fatty tissue covered by peritoneum measuring 6.2 x 3.3 x 0.5 cm. The peritoneal surface displayed patchy fibrinous exudates. Sectioning revealed yellow adipose tissue with no identifiable appendix. Microscopically, the entire specimen demonstrated a poorly formed, mainly fatty appendix without a discernible lumen or submucosal lymphoid tissue. There were scattered sparsely distributed non-continuous bundles of smooth muscle (muscularis propria) at the periphery, which were highlighted by desmin and trichrome stains. This atretic appendix, mesoappendix and peritoneal covering were acutely inflamed. The final diagnosis was poorly formed, acutely inflamed fatty appendix consistent with congenital appendiceal atresia with accompanying acute periappendicitis. Results (if a Case Study enter NA) NA Conclusion This case would add to the very limited existing literature for congenital appendiceal anomalies and highlight the importance of thorough surgical intraoperative abdominal exploration and submission of the entire specimen for microscopic examination in order to render a definitive diagnosis.

Initial Experience of Long-Term Prophylaxis with Lanadelumab for Hereditary Angioedema in China: A Clinical Observation Study on Six Patients

Plain Language SummaryHereditary angioedema (HAE) is a rare genetic disease characterized by recurring episodes of painful swelling of the subcutaneous and submucosal tissue, and its pathogenesis is due to the deficiency or dysfunction C1-esterase inhibitors. HAE attacks can affect many areas of the body, but most frequently involve the extremities, gastrointestinal tract, genitals, face, and upper airway. Swelling of the larynx can occur, with potentially fatal consequences owing to asphyxiation. Since 2020, China has had the only first-line treatment drug that can prevent HAE attacks – lanadelumab. Our study evaluated the efficacy and safety of lanadelumab by observing the 6 patients in China mainland who were the first to use it. Our research showed that lanadelumab can prevent the attack of HAE, greatly improve the quality of life of patients, and has good safety. A reasonable dosage plan can ensure stable therapeutic effects of lanadelumab. In addition, the efficacy of lanadelumab remained stable during COVID-19 vaccination and infection.

PRP improves the outcomes of autologous skin graft transplantation on the esophagus by promoting angiogenesis and inhibiting fibrosis and inflammation.

Autologous skin graft (ASG) transplantation is a challenging approach but a promising option for patients to prevent postoperative esophageal stricture. Nonetheless, the current strategies require improvement. We aimed to investigate the effectiveness of the injection of platelet-rich plasma (PRP) before skin graft transplantation for extensive esophageal defects after endoscopic resection. Standardized complete circular endoscopic resection (5 cm in length) was performed in 27 pigs allocated into 3 groups. The artificial ulcers were treated with a fully covered esophageal stent (control group), ASG (ASG group), and submucosal injection of PRP with ASG (PRP-ASG group). Macroscopic evaluation and histological analysis of the remolded esophagus were performed 7, 14, and 28 days after surgery. The macroscopic evaluation indicated that submucosal injection of PRP before transplantation effectively promoted the survival rate of skin grafts and decreased the rate of mucosal contraction compared with those treated with ASG or stent alone. Histological analysis of submucosal tissue showed that this modified strategy significantly promoted wound healing of reconstructed tissues by enhancing angiogenesis, facilitating collagen deposition, and decreasing inflammation and fibrogenesis. These findings suggested that PRP might be used as a biological supplement to increase the esophageal skin graft survival rate and improve submucosal tissue remolding in a clinically relevant porcine model. With extremely low mucosal contraction, this novel combination strategy showed the potential to effectively prevent stenosis in extensive esophageal ulcers.

Does Changes in the Muscles Beneath the Submucosal Tissues Necessitate a Novel Strategy in the Medical Management of OSMF: A Systematic Review.

This study is envisioned to assess the structural changes the muscles undergo beneath the submucosal tissues and whether these changes necessitate a novel strategy from the existing conventional modality in the treatment of oral submucous fibrosis (OSMF) medically through a systematic literature survey. Literature search was performed electronically using Medline, EMBASE and CENTRAL databases to identify published literature until the end of April 2024 in dental, oral and maxillofacial surgery, plastic surgery and otolaryngology journals containing the terms "oral submucous fibrosis", "muscles of mastication", "muscles of facial expression", "histopathologic study", "ultrasonographic study", "CT", "MRI" in either their titles, abstracts, and keywords with only English being the preferred language. The data was extracted from the selected articles and prudently studied to gather and compile the data. Descriptive data from all the carefully chosen articles were selected and analysed. Seven studies met the inclusion criteria. It was observed that the masseter muscle was the first to be involved in the disease process of OSMF among the muscles of mastication and facial expression. It was observed that the anterior temporalis and orbicularis oris muscles remained unaffected. However, the buccinator muscle which lies in utmost vicinity is not evaluated in the included studies. The degree of muscle degeneration and the degree of disease progression were directly related to the duration of the habit. The restricted mouth opening noticed in OSMF is not only governed by the subepithelial fibrosis but also on the extent of muscle degeneration. The changes the surrounding muscles undergo could be a manifestation of the disease, atrophy as a sequalae to the limited functional activity of the muscles which is brought about by fibrosis or it could be an essential part of the disease itself.

Use of Fresh Frozen Plasma in a Dramatic Case of ACE-Inhibitor Associated Angioedema

Angioedema describes a non-dependent, non-pitting and transient edema caused by the accumulation of vasoactive substances in the circulation. These vasoactive substances increase vascular permeability, causing swelling of the deep dermal, submucosal or subcutaneous tissues of the face, lips, neck, extremities or gastrointestinal tract. Urticaria may or may not accompany this condition. Angioedema is generally mediated through two pathways: histamine-mediated and bradykinin-mediated. Histamine-mediated angioedema generally responds to standard therapeutic measures (such as antihistamines, steroids and epinephrine), whereas bradykinin-mediated angioedema can be more difficult to manage in emergency departments (ED). Here, we present a patient who presented to our ED with bradykinin-mediated ACE-I-associated dramatic angioedema clinic, did not respond to standard treatments, rapidly improved with fresh frozen plasma (FFP) administration and was discharged after 6 days of follow-up in the emergency critical intensive care unit.

Advent of oral medications for the treatment of hereditary angioedema.

Hereditary angioedema (HAE) is a rare genetic disorder characterized by unpredictable, debilitating episodes of submucosal and/or subcutaneous tissue swelling, which may be life-threatening depending on anatomic location. The two primary management strategies for HAE are ready access to effective on-demand treatment in all patients and the prevention of attacks (short-term prophylaxis [STP] and long-term prophylaxis [LTP]) in appropriate patients. All approved on-demand and most LTP medications require subcutaneous or intravenous administration. Injection-related challenges include trypanophobia (fear of needles), difficulty with self-administration, injection-site reactions (e.g., pain, erythema, bleeding, bruising), and anxiety-all contributing to poor compliance and administration delays. Oral HAE treatments may improve outcomes by reducing treatment barriers. To review oral therapies, approved or in development, for on-demand treatment and/or prevention of HAE attacks. To provide a comprehensive review, data was obtained from publicly available resources through a targeted PubMed literature review and supplemented by information provided on company websites (search cutoff of May 31, 2024). Berotralstat, an oral plasma kallikrein (PKa) inhibitor, is approved for LTP. Sebetralstat, another PKa inhibitor, is the investigational first oral on-demand HAE treatment to complete a phase 3 trial. Deucrictibant, an oral bradykinin B2 receptor antagonist, has completed phase 2 trials for on-demand therapy and LTP. Several other oral PKa inhibitors (ATN249, VE-4666, and VE-4062) are in early development for LTP. Substantial advances have been made in the development of oral treatments for HAE. These treatments have the potential to improve and optimize clinical outcomes, satisfaction, and quality of life among patients with HAE.

SFRP1 reduces neutrophil infiltration and inhibits the Wnt/β-catenin pathway to alleviate oral submucous fibrosis.

Oral submucous fibrosis (OSF) is a precancerous condition characterized by oral mucosal atrophy with fibrosis of the submucosal tissue. OSF has a high prevalence, and treatment requires improvement. Our study aims to investigate the role and mechanism of secreted frizzled-related protein 1 (SFRP1) in OSF. We constructed an arecoline-induced OSF mice model. Through Pearson's correlation analysis, we investigated the association between SFRP1 levels and expressions of proteins related to the Wnt/β-catenin signaling pathway, as well as the correlation between SFRP1 levels and the degree of neutrophil infiltration. Moreover, neutrophil infiltration intensity, tissue fibrosis degree, and levels of β-catenin, Cyclin D1, and c-myc were evaluated after SFRP1 overexpression treatment through immunohistochemical and biochemical assays. A Wnt/β-catenin pathway activator was used to investigate the molecular mechanism of SFRP1 in the arecoline-induced OSF cell model. Compared with the control group, mice in the OSF group exhibited increased collagen deposition and more severe fibrosis in the oral mucosal tissue (OMT). In the OMT of OSF mice, the levels of SFRP1 were decreased. The levels of SFRP1 exhibited a negative correlation with the levels of Wnt/β-catenin proteins and neutrophil infiltration in the OMT. Upon SFRP1 overexpression, there was a reduction in neutrophil infiltration and fibrosis in the OMT, as well as inhibition of Wnt/β-catenin-related proteins. In vitro, the Wnt/β-catenin pathway activator further reversed the effect of SFRP1 overexpression on OSF. SFRP1 attenuates OSF by reducing neutrophil infiltration and inhibiting the Wnt/β-catenin pathway.

OUR EXPERIENCE IN SURGICAL TREATMENT OF MUCOSAL HYPERTROPHY OF TORI TUBARII

Puprose. Evaluation of the effectiveness of surgical treatment of mucous hypertrophy of tori tubarii by submucosal tissue destruction using Ho:YAG laser radiation. Materials and methods. The study involved 48 adult patients with symptoms of Eustachian tube dysfunction. The patency of the auditory tube was assessed by standard tests, the ETDQ 7 questionnaire, tympanometry, pure tone threshold audiometry, and endoscopic video recording of the results were performed. Surgical intervention was carried out by forming under the influence of pulsed radiation from a Ho:YAG laser with a frequency of 10 Hz and a pulse energy of 2 J, 4–6 tunnels with a depth of 5–7 mm in the hypertrophied mucous membrane of the torui tubarii along the posteromedial surface and 2 tunnels up to 3 mm up and down from the pharyngeal mouth of the auditory tube. The control periods after surgery were 1, 3 and 6 months. Results. A significant improvement in the results of the auditory tube according to ETDQ-7 was noted by 3 months after surgery in 71% of patients and in 84% by 6 months. By 6 months after surgery, type C tympanometry and clinically significant conductive hearing loss persisted in 8 and 5% of patients, respectively. The subjective feeling of fully performing the Valsalva test improved in 58% after 3 months and in 82% by the 6th month, and the Toynbee test in 42% and 64% in the 3rd and 6th months, respectively. In 16% of patients, despite a visual decrease in mucosal hypertrophy during endoscopic examination, signs of dysfunction remained according to ETDQ 7. There were no complications after surgical treatment during 6 months of observation. Conclusion. The use of endoscopic diagnosis of the nasopharynx in patients with signs of dysfunction of the auditory tubes in combination with functional tests and the ETDQ-7 questionnaire allows to determine the indications for the surgical treatment of hypertrophy of the mucous membrane of the tori tubarii using the Ho:YAG laser, the effectiveness of which in our study was 84%.

Oral Mucocele in Pediatric Patient: A Case Report

Mucoceles can appear anywhere on the oral mucosa where there are minor salivary glands. Because the diagnosis is mostly clinical in character, it is important to appropriately do the anamnesis in order to look for any prior trauma. Extravasation and retention mucocele are the two main forms that can develop. Although retention mucoceles can appear anywhere, extravasation mucoceles typically occur on the lower lip. Histologically, mucoceles can be divided into extravasation types and retention types, with extravasation types being more prevalent. The extravasation mucocele, also known as a "mucous retention cyst," lacks an epithelial lining and a defined border. It is thought that trauma to a small salivary gland excretory duct causes an extravasation mucocele to occur. Saliva pools in the nearby submucosal tissue as a result of duct laceration, which causes edema. The obstruction of a minor salivary gland duct, frequently by a sialolith, periductal scarring, or tumor, results in the retention type mucocele. Saliva builds up and the duct enlarges due to the obstruction of salivary flow. A 9-year-old child arrived to Rumah Sakit Gigi dan Mulut Universitas Muhammadiyah Yogyakarta with his mother, complaining of a lump on his lower lip. Patient frequently bit his lips since the lump has been there for a few months. It did not hurt and occasionally grew in size. The lump bothered the patient. The dentist performed minor surgery to remove the mucocele. Minor surgery was performed with infiltration anesthesia around the mucocele and then used blade no. 15 for excision of the mucocele. For postoperative wounds, braided surgical sutured silk was used. Post-operative instructions were given, antibiotics and analgetic were prescribed. Patient was recalled after 1 week for the removal of sutures. No recurrence was seen after a follow up at 1 month and 3 months.International Journal of Human and Health Sciences Supplementary Issue 01: 2024 Page: S53

Mentalis nerve branches supplying the lower lip revisited: a study of human fetuses and donated elderly cadavers.

Little information is known about the mentalis nerve course from the lower lip approximation margin (free margin) to the upper lip. Likewise, no difference in nerve distribution has been observed between the cutaneous and mucosal parts of the lip. Therefore, this study reexamined mentalis nerve morphology. For macroscopic observations, three fresh cadavers were dissected (one male and two females; aged 78-93). We also evaluated histological sections obtained from five donated elderly cadavers (two males and three females, aged 82-96 years) and 15 human fetuses (11-40 weeks or crown-rump length 80-372mm). Immunohistochemical analysis for S100 protein and tyrosine hydroxylase was performed. In both fetuses and adult cadavers, one to three nerve branches ran upward in the submucosal tissue from the mental foramen. Near the free margin of the lip, some branches passed through the orbicularis oris muscle layer toward the lip skin, whereas others followed a reversed J-shaped course along the free margin. Nerve twigs ran in parallel beneath the mucosa, whereas wavy nerve twigs attached to the basal lamina of the lip epidermis. The difference in nerve endings abruptly occurred at the skin-mucosal junction. Tyrosine hydroxylase-positive sympathetic nerve twigs surrounded arteries and formed a branch composed of S100-negative unmyelinated fibers. The lower lip skin was innervated by a perforating branch passing through the orbicularis oris muscle, that was different from the lip mucosa. A sudden change in the nerve ending configuration at the mucocutaneous junction seemed to develop postnatally.

Is Submucosal Lipomatosis of the Appendix Vermiformis Really a Rare Entity?

Background: Acute appendicitis (AA) is the most common surgical emergency in patients who visit the emergency department with abdominal pain. In some of the patients who were operated with a prediagnosis of AA, lymphoid hyperplasia, fecalitis, enterobius vermicularis, carcinoid tumor, or adenoma are determined without transmural inflammation in microscopic examination of the appendix. 'Submucosal lipomatosis' is also another entity that has been rarely reported in appendix localization. In this study, we aimed to determine the frequency and severity of submucosal fatty tissue (SFT) in appendectomy specimens and identify risk factors. Materials and Methods: 293 appendectomy specimens were evaluated retrospectively. The amounts of SFT (A0: None, A1: Isolated adipocytes (Mild), A2: Small adipocyte groups (Moderate), A3: Prominent adipocyte groups (Marked), A4: Severe adipocyte groups that narrow the lumen (Severe)) and the groups that were created according to the amounts of SFT (Group 1: Cases with A1,2,3,4, group 2: Cases with A2,3,4, group 3: Cases with A3,4) were determined in hematoxylin-eosin sections. Results: 91.47% of the cases had any amount of SFT. Amounts of SFT were mild in 23.89%, moderate in 46.76%, marked in 18.09%, and severe in 2.73%. All of the cases without SFT were in pediatric age. When the amount of SFT increased, the mean age and adult rate increased regularly (p&amp;lt;0.05). As 68% of the cases without SFT were female, male predominance was observed in cases with SFT. When the amount of SFT increased, male rate increased regularly (p&amp;lt;0.05). AA wasn’t determined in 26,28% of the cases. The AA rate in the group without SFT (20%) was marked lower than group 1 (78,73%), group 2 (82,32%), and group 3 (83,87%) (p&amp;lt;0.05). The most prominent increase in AA rate was between the group without SFT and group 1 which was the most sensitive group to the amount of SFT. When group 1,2,3 were compared, no significant increase in the AA ratio was found. Conclusions: The presence of SFT in the appendix is a common condition. Age increase and male gender are risk factors for the accumulation of SFT. Due to SFT accumulation increases the risk of AA, it would be logical to classify it as mild/moderate/marked/severe, and accept it as 'Submucosal lipomatosis'.

Definition, acronyms, nomenclature, and classification of angioedema (DANCE): AAAAI, ACAAI, ACARE, and APAAACI DANCE consensus

BackgroundAngioedema (AE) manifests with intermittent, localized, self-limiting swelling of the subcutaneous and/or submucosal tissue. AE is heterogeneous, can be hereditary or acquired, occurs only once or be recurrent, with or without wheals, due to mast cell mediators, bradykinin or other mechanisms. Currently, different taxonomic systems are used, making it difficult to compare the results of studies, develop multicenter collaboration, and harmonize treatments of AE patients. ObjectiveTo develop a consensus on the definition, acronyms, nomenclature, and classification of angioedema (DANCE). MethodsThe initiative involved 91 experts from 35 countries and was endorsed by 53 scientific, medical societies, and patient organizations. A consensus was reached by online discussion and voting using the Delphi process over a period of 16 months (June 2021 to November 2022). ResultsThe DANCE initiative resulted in an international consensus on the definition, classification and terminology of AE. The new consensus classification features five types and endotypes of AE and a harmonized vocabulary of abbreviations and acronyms. ConclusionThe DANCE classification complements current clinical guidelines and expert consensus recommendations on the diagnostic workup and treatment of AE. DANCE does not replace current clinical guidelines and expert consensus algorithms and should not be misconstrued in a way that affects reimbursement of medicines prescribed by a physician using sound clinical judgment. We anticipate that the new AE taxonomy and nomenclature will harmonize and facilitate AE research and clinical studies, thereby improving patient care.

Thickened submucosal adipose tissue layer during endoscopic submucosal dissection of inflammatory bowel disease dysplasia

Thickened submucosal adipose tissue layer during endoscopic submucosal dissection of inflammatory bowel disease dysplasia

Mucocele Treatment in Pediatric Patient at RSGM UMY

Background : Mucoceles is minor salivary gland lession. The extravasation mucocele, commonly referred to as a "mucous retention cyst," does not have an epithelial lining or a well-defined boundary. An extravasation mucocele is believed to be caused by damage to a tiny salivary gland excretory duct. Saliva accumulates in the adjacent submucosal tissue due to a tear in the duct, leading to swelling. Retention type mucocele occurs when a small salivary gland duct is blocked, often by a sialolith, periductal scarring, or tumor. Salivary flow blockage leads to the accumulation of saliva and the enlargement of the duct. Objective : To provide treatment for mucocele in a pediatric patient at RSGM UMY Case Report : A 9-year-old patient came to RSGM UMY accompanied by his mother, complain he has swelling on lower lip. He often bite the lower lip for a long time. It is painless and sometimes increases in size. His experiencing discomfort due to the bump. Method : The mucocele was excised using infiltration anesthetic and a blade no. 15. Surgical sutured silk braided was utilized for postoperative wound closure. The patient was provided with post-operative instructions and prescribed antibiotics and analgesics. The patient was scheduled for a follow-up appointment after one week to have the sutures removed. Result : No complaints after control 1 month and 3 months after treatment Conclusion : Surgical removal remains the optimal choice for treating mucoceles due to its simplicity and cost-effectiveness compared to laser ablation, cryosurgery, and electrocautery

Reconstruction of Urethral Sphincter With Polyacrylamide Hydrogel.

Urethral bulking is an alternative to synthetic midurethral sling for the treatment of stress urinary incontinence (SUI) in women. Urethral bulking agents, which are injected in the submucosal tissues of the proximal urethra/bladder neck, have demonstrated less adverse effects with similar satisfaction rates but lower subjective and objective cure rates when compared with midurethral sling. Cystoscopic Reconstruction of External Sphincter Technique (CREST) is a novel technique, which reinforces the natural closure mechanism of the external urinary sphincter (EUS). The aim of the study was to provide safety and efficacy data for injecting polyacrylamide hydrogel (PAHG) in the components of the female EUS. This was a retrospective chart review of patients using CREST with PAHG as initial treatment for SUI by a single surgeon from January 2022 to October 2022. Exclusion criteria are as follows: younger than 18 years, prior SUI surgery, concomitant pelvic organ prolapse or reconstructive procedure, neurological conditions, or history of radiation. Subjective and objective cure rates were measured by patient-reported symptoms and cough stress test. Urinary retention, postoperative urinary infection, and de novo urinary urgency were assessed. One hundred and thirteen consecutive patients met inclusion criteria with median follow-up of 3 months. Eighty-five percent of participants reported subjective improvement, 69% reported subjective cure, and 69% demonstrated objective cure. Nine patients reported transient postoperative retention, 8 reported postoperative urinary tract infections, and 5 reported de novo urgency. There were no serious adverse events. CREST is a novel technique for injection of PAHG, into the EUS to treat SUI. Our data suggest that this technique could improve urethral injection outcomes with minimal complications.

The role of cap-assisted endoscopy and its future implications.

Cap-assisted endoscopy refers to a procedure in which a short tube made of a polymer (mostly transparent) is attached to the distal tip of the endoscope to enhance its diagnostic and therapeutic capabilities. It is reported to be particularly useful in: (1) minimizing blind spots during screening colonoscopy, (2) providing a constant distance from a lesion for clear visualization during magnifying endoscopy, (3) accurately assessing the size of various gastrointestinal lesions, (4) preventing mucosal injury during foreign body removal, (5) securing adequate workspace in the submucosal space during endoscopic submucosal dissection or third space endoscopy, (6) providing an optimal approach angle to a target, and (7) suctioning mucosal and submucosal tissue with negative pressure for resection or approximation. Here, we review various applications of attachable caps in diagnostic and therapeutic endoscopy and their future implications.

(223) Using Aglan Flap in Peyronie`s Surgery

Abstract Introduction Surgical therapy is indicated if: 1- Deviation compromises or makes sex practice impossible. 2- Conservative treatment has failed. 3- Disease duration is at least 12 months. 4- The stable phase is at least 6 months. When deviation is greater than 60 degrees many centers prefer a grafting procedure to avoid penile shortening, grafting procedures leads to potential lengthening of the concave side of the deviation. The resulting tunical defect may be filled using an auto graft .e.g. detubulerized saphenous vein, fascia-lata, buccal mucosa, allograft e.g human pericardial tissues and human fibrinogen and thrombin coated onto equine collagen sponge, or xenografts e.g bovine pericardial and bovine intestinal submucosal tissues. Currently there is no consensus on the most suitable graft material for penile graft, many surgeons used synthetic grafts e.g self-adhesive collagen fleece, we were used the elastic wall of silicone caps with penile implants as a cover to the defects during implantation with peyronie`s previously. Synthetic grafts has the risk of infection, sensory loss, altered glans sensation, recurrent curvature due to graft contraction and length loss. So synthetic grafts should be avoided. Penile plication is simple and minimally invasive but invariably may results in penile length loss and may in fact worsen the existing hour-glass or hinge effect. Objective Presentation of new method to cover defects in peyronie`s diseases. Methods Methods two patients were operated, excision of the plaque was done, dissection of caval tissues in subtunical plane, elevation of Aglan caval flap, penile implantation (maliable), covering of the implant by the flap and suturing, second layer of the nearby tissues was added. The dissection could be done up to 360 degrees. Results Follow up for six months was done, both patients have no complications initial decrease in sensation was reported, improved within 3 months completely, the flap is safe, very vascular could be based at any point. It is natural, economic with minimal side effects if compared with synthetic grafts. Obvious nerves at area of excision should be retracted away if possible for maintenance of sensation. It could be used to cover defects with peyronie`s or other tunical defects with implantation. Conclusions Aglan flap is safe, economic, simple and effective method for covering tunical defects in peyronie`s disease. Disclosure No.