Temporary Stent Research Articles

85. Hematometrocolpos due to Graft versus Host Disease in Two Young Patients: Case Reports and a Review of the Literature

<h3>Background</h3> The differential diagnosis of primary or secondary amenorrhea includes obstructive pathologies such as vaginal stenosis. Vaginal stenosis can be acquired as a result of vaginal graft versus host disease (GVHD) in patients who have undergone hematopoietic stem cell transplant (HSCT). The true prevalence of vaginal GVHD is unknown, and young patients in particular are at risk for missed or delayed diagnosis, with the potential for severe complications such as vaginal stenosis and secondary hematometrocolpos. This case report demonstrates the potential for blunt dissection of vaginal adhesions along a tissue plane in cases of vaginal stenosis secondary to vaginal GVHD, and underscores the importance of increased physician awareness of vaginal GVHD in adolescents and increased screening for vaginal GVHD in at-risk adolescent patients. <h3>Case</h3> We report two cases of vaginal adhesions and hematometrocolpos secondary to vaginal GVHD in a 14-year-old patient and a 24-year-old patient, both with histories of allogeneic HSCT. Resolution of hematocolpos was obtained with surgical lysis of vaginal adhesions and temporary vaginal stent placement in both patients, followed by systemic and topical hormone therapy and, in the 24-year-old, dilator therapy. Future vaginal dilator versus surgical therapy is planned for the 14 year-old patient. <h3>Comments</h3> Vaginal stenosis secondary to vaginal GVHD must be considered with patients with a history of allogeneic HSCT who present with primary or secondary amenorrhea. Surgical management may be able to identify a residual plane of the normal vaginal canal, which may avoid the need for vaginal replacement and restore normal anatomy. The use of vaginal stents can facilitate attempts to restore normal anatomy and prevent restenosis, along with adequate postoperative medical and dilator management as appropriate. This complex diagnosis warrants careful treatment and surveillance that are bolstered by a strong physician-patient relationship and patient motivation to participate in care. These cases demonstrate that a tissue plane can be identified even in cases where the vagina appears completely stenotic. As HCST transplant success rates continue to increase, the occurrence of GVHD and vaginal GVHD in adolescents and young adults is anticipated to rise. The increasing incidence of vaginal GVHD and the potential for underdiagnosis supports a need for routine screening and education in adolescent and young adult patients who are at risk for vaginal GVHD.

Including Medical Management in the Urologic Approach to Idiopathic Retroperitoneal Fibrosis

ObjectiveTo characterize the timing and effectiveness of medical management in resolving stent-dependent ureteral compression secondary to idiopathic retroperitoneal fibrosis (RPF), the long-term relevant outcomes, and the side effects of treatment. MethodsA retrospective review of RPF patients diagnosed from 2002-2018 was performed. Patients with hydronephrosis due to ureteral involvement that were managed with medication and with temporary stenting as needed, but without initial ureterolysis, were included. Patient demographics and RPF management details were obtained, including the following subsequent events: ureterolysis, nephrectomy, recurrent upper tract obstruction, and medication side effects. ResultsFifty-two patients met inclusion criteria. Resolution of ureteral obstruction with medical management and temporary renal drainage as needed occurred in 36 (69%) patients with a median stent duration of 16 months, and median clinical and radiographic follow up of 4.2 and 3.3 years, respectively. Recurrent obstruction after a stent-free period occurred in 9 (18%) patients. Ureterolysis was performed in 8 (15%) patients at a median of 2.2 years for medication intolerance, lack of radiographic response to medication, or persisting pain. Potential medication side effects occurred in 6 (12%) patients. ConclusionsMedical management supported successful resolution of ureteral obstruction in 69% of patients without the need for ureterolysis after temporary renal drainage using stents, with rare incidence of worsening renal dysfunction or medication side effect. To date, this is the largest reported series of systematically managed RPF patients with obstructive uropathy receiving initial medical therapy and serves to counsel patients and advise urologists and nephrologists of the expected course and advantages and disadvantages of medical versus surgical management.

Combination of temporary bridging device (Comaneci) and permanent stenting in the treatment of unruptured wide neck bifurcation aneurysms.

The double stent-assisted techniques for the treatment of wide neck bifurcation aneurysms (WNBAs) may be more complicating than single stent-assisted or balloon-assisted coiling. The Comaneci device (Rapid Medical, Yokneam, Israel) is a new temporary bridging device developed for covering the aneurysm neck during coiling. This new design enabled us to treat unruptured WNBAs with the use of single stent-assisted coiling instead of double stent in eight patients. At the 1-year angiographic follow-up, there was no filling in any aneurysm. There was no mortality or morbidity cases related to the procedure. In this study, we are reporting our experience of using single stent-assisted coiling combined with a Comaneci device in the treatment of unruptured WNBAs.

Endoscopic Management of Dysphagia

Dysphagia is difficulty in swallowing that can be caused by a number of disorders that involve either the oropharynx or the esophagus. Specific endoscopic treatment for dysphagia depends on its etiology, whether the dysphagia is caused by mechanical narrowing or a motor disorder. Variable endoscopic treatment strategies can be used to manage dysphagia. Patient with dysfunction of the upper esophageal sphincter may benefit from esophageal dilationor injection of botulinum toxin. Pneumatic balloon dilation, injection of botulinum toxin, peroral endoscopic myotomy can be considered as treatment options for esophageal motility disorders. Endoscopic dilation is the treatment choice of esophageal stricture, while intraluminal steroid injection and temporary stent can be considered in refractory benign esophageal stricture. Self-expandable metal stent insertion can be considered for dysphagia with malignant cause.

The efficacy of alpha-1A blocker (tamsulosin), antimuscarinic (solifenacin) and their combination in the management of double-J stent-related lower urinary tract symptoms: a randomized controlled study

BackgroundThe insertion of a double-J (DJ) stent is considered a routine and necessary urological procedure. It can cause lower urinary tract symptoms (LUTS). Pharmacologic management is one of many trials that were done to improve these symptoms, particularly the administration of alpha-1A blockers and antimuscarinics medications. This trial aimed to evaluate the efficacy of alpha-1A blocker (tamsulosin), antimuscarinic (solifenacin), and their combination in managing DJ stent-related LUTS.MethodsThis prospective, randomized, comparative, and nonblinded trial was conducted between November 2016 and October 2018. Eligible patients were between 18 and 50 years of both genders who underwent temporary retrograde unilateral Double-J stent fixation. Patients were randomized to four groups; group I was control (drug-free), group II received tamsulosin 0.4 mg, group III received solifenacin 5 mg, and group IV received the combination of tamsulosin and solifenacin. All patients completed the IPSS, QoL, and VAS questionnaires at both pre-insertion day of the stent and 2 weeks postoperatively; the data obtained were compared to all four groups.ResultsThe study included 143 patients (78 males, 65 females). There was no statistically significant difference between the four groups regarding age, sex, side, and DJ placement indications. In comparison with the control group, there were statistically significant differences in all scores in favor of groups II, III, and IV. Compared to groups II and III, there were statistically significant differences in overall IPSS, QoL, and VAS scores in group IV. No significant differences were found between the tamsulosin and solifenacin groups.ConclusionThe alpha-1A blocker (tamsulosin) or antimuscarinic (solifenacin) monotherapy effectively improves the DJ stent-related LUTS and the QoL of patients with no advantage with either drug. The combination therapy of both pharmacotherapies is significantly effective than drug monotherapy.

Accumulative traction-hoisting construction technology of a semi-rigid steel batten cable dome

A new structure called a steel-batten cable dome (SBCD) is proposed in this study. By replacing flexible ridge cables to semi-rigid steel battens, this structure is provided with the characteristics of good integrity and large local stiffness to support heavy rigid roofing systems. In addition to avoid installing large amount of temporary stent, the accumulative traction-hoisting construction technology (ATHC) was present, with the feathers of few brackets, small lifting force, and high efficiency of tensioning. Moreover, the modified NDFEM form-finding method is introduced to simulate the construction process of ATHC. The results show that the SBCD model and the conventional cable dome (CCD) model both experienced the traction-hoisting stage, the adjustment stage, and the rigid stage to build sufficient stiffness to withstand external load, with their overall shapes changing from “ω” to “m”, and finally reach their designed states. Total stresses of the steel battens are within 85 MPa before final forming and 250 MPa after construction, which ensures the stable state for the steel batten grid and the elastic state of the entire structure. Furthermore, ATHC can be applied for both SBCDs and CCDs, while a SBCD could be simplified to a similar CCD to optimize the calculation efficiency.

Decision-making from international master surgeons regarding operative techniques for pancreatic-enteric anastomotic reconstruction during pancreatoduodenectomy

Purpose: To evaluate decision-making processes and practice habits from international experts regarding pancreatico-enteric anastomotic creation during pancreatoduodenectomy (PD). In fact, despite ample retrospective studies and RCTs, no consensus exists concerning optimal techniques for pancreatico-enteric anastomotic reconstruction. Method: A questionnaire was completed by 60 select international pancreatic surgery experts from 22 countries (median career pancreatectomy/PD volumes: 1200/705). Their thought-processes and practice regarding pancreatico-enteric anastomotic technique were explored through checkbox questions, free-text responses, and clinical vignettes. Results: Technical considerations and approaches employed during PD by these master surgeons are displayed in Figure. Retrocolic trans-mesenteric orientation of the pancreatic-biliary limb is by far the preferred approach (78%). Duct-to-mucosa (DTM) pancreatico-jejunostomy (PJ) is the most frequently adopted technique (78%), through either the Cattel-Warren (45%) or Blumgart approach (33%). Conversely, both dunking PJ and pancreato-gastrostomy (PG) are rarely employed (<5%). Notably, all surgeons employ some tools to improve sewing precision, such as ocular loupes (45%), temporary internal stents (43%) or headlights (37%). For both PJ and PG, the majority employ 3-0, non-absorbable sutures for the outer layer, and finer, absorbable, monofilament sutures (6-0, 5-0, 4-0) for the inner layer - particularly for duct-to-mucosa PJ (5-0: 64%). Half of surgeons believe that suture material influences anastomotic healing, whereas only 14% usually adapt their choice based on parenchymal characteristics.When encountering a ≤1mm pancreatic duct, 61% of surgeons would dilate it using a probe and 59% would cut back further and still try a DTM anastomosis, whereas directly performing a dunking PJ or a PG is infrequently applied (≤10%). If this initial approach was unsatisfactory, two-thirds would opt for a dunking/invaginating PJ, 22% would perform PG, and just 3% would apply duct occlusion/completion pancreatectomy. Conclusion: Even at the expert level, approaches to this anastomosis are non-uniform, and their relative effectiveness in yielding optimal outcomes are still unresolved

An update on vessel preparation in lower limb arterial intervention

BackgroundPlain balloon angioplasty has traditionally been used to treat lower limb arterial disease but can be limited by significant residual stenosis, vessel recoil, dissection, and by late restenosis. Appropriate vessel preparation may significantly improve short and long-term outcomes. We aim to give an overview of some of the devices currently available, or under investigation, for vessel preparation in the lower limb.Main textVessel preparation devices include those that remove plaque (atherectomy devices) and those that modify plaque.The four groups of plaque removing atherectomy devices are defined by their plaque removal method: Directional, rotational orbital and excimer laser are categories of devices investigated for plaque modification.Intravascular lithotripsy devices generate sonic pulsatile pressure waves that pass into the vessel wall cracking calcified plaques whilst sparing soft tissue. This enables dilatation of calcified lesions at low pressure by conventional balloons and enables full stent expansion.Other balloon based vessel preparation devices were designed to modify plaque and produce more controlled, lower pressure luminal expansion without major dissections and potentially with less recoil than conventional angioplasty balloons. Scoring balloons have a helical nitinol element attached to the balloon that scores plaque facilitating uniform luminal enlargement. Further specialty balloons have been developed in recent years, including the Chocolate, Phoenix and Serranator balloons. Finally, the temporary Spur self-expanding retrievable nitinol stent has a series of radially aligned spurs that are driven into the vessel wall by post-dilatation, potentially improving drug delivery.ConclusionLesion specific vessel preparation aims to improve both short and long term outcomes through improved penetration of anti-proliferative drug, maximising luminal gain, reducing the need for stent placement and minimising intimal injury. Some forms of vessel preparation appear to improve short term outcomes; long-term outcomes remain uncertain. An overview of some of the multiple devices available for vessel preparation is presented.

Interventional radiology in the prevention of bile duct anastomotic stricture during reconstructive surgery for the iatrogenic bile duct injury (one center experience)

Aim . To study the possibility of using radiological interventions in the staged treatment of intraoperative bile ducts injury and the prevention of biliodigestive anastomotic stricture. Materials and methods . A retrospective analysis of the treatment of 20 patients with “large” (classes B—E) iatrogenic damage to the extrahepatic biliary tract was performed. In all cases, percutaneous transhepatic cholangiostomy was performed before reconstructive Roux-en-Y hepatico- or bighepaticojejunostomy. Biliary drains installed before surgery were retained to control the anastomosis in the early postoperative period, as well as for 6 months for possible correction of the forming narrowing. Preoperatively established biliary drains were retained to control the anastomosis in the early postoperative period, as well as for 6 months for possible correction of the anastomotic stricture. Results . In 2 cases with a B-class injury, it was possible to restore the patency of the common hepatic duct by balloon dilatation without subsequent reconstructive surgery. Roux-en-Y hepatic or (bihepatico)-jejunostomy was performed in 18 patients. In 10 cases antegrade interventional radiological reconstruction of the common bile duct was performed on the external-internal drainage, including 4 cases with partial excision of the common bile duct (class E). Temporary (6 months) antegrade stenting of the partially excised right lobe duct and the confluence zone was performed in 2 cases with trauma classes D and E. There were no lethal outcomes or complications of interventional radiological surgery. Narrowing of the anastomosis was avoided in all patients. The follow-up period varied from 6 months to 13 years. Conclusion . Regardless of the period of detection of biliary tract injury in the postoperative period, tactics of stage treatment, involving the drainage of the biliary tree, with subsequent endoscopic or radiologic intervention, are advisable. Percutaneous biliary drainage in case of “large” iatrogenic injuries of the bile ducts in the postoperative period makes it possible to control biliodigestive anastomosis, timely detect and adequately correct its stricture.

A prospective randomized study to define the role of low dose continuous prophylactic antibiotics and anti-adherence agents in altering the microbial colonization related to indwelling double‐J stents

ObjectiveDespite conflicting evidence, it is common practice to use continuous antibiotic prophylaxis (CAP) in patients with indwelling double-J (DJ) stents. Cranberry extracts and d-mannose have been shown to prevent colonization of the urinary tract. We evaluated their role in this setting. MethodsWe conducted a prospective randomized study to evaluate patients with indwelling DJ stents following urological procedures. They were randomized into three groups. Group A (n=46) received CAP (nitrofurantoin 100 mg once daily [OD]). Group B (n=48) received cranberry extract 300 mg and d-mannose 600 mg twice daily (BD). Group C (n=40) received no prophylaxis. The stents were removed between 15 days and 45 days after surgery. Three groups were compared in terms of colonization of stent and urine, stent related symptoms and febrile urinary tract infections (UTIs) during the period of indwelling stent and until 1 week after removal. ResultsIn Group A, 9 (19.5%) patients had significant bacterial growth on the stents. This was 8 (16.7%) in the Group B and 5 (12.5%) in Group C (p-value: 0.743). However, the culture positivity rate of urine specimens showed a significant difference (p-value: 0.023) with Group B showing least colonization of urine compared to groups A and C. There was no statistically significant difference in the frequency of stent related symptoms (p-value: 0.242) or febrile UTIs (p-value: 0.399) among the groups. ConclusionProphylactic agents have no role in altering bacterial growth on temporary indwelling DJ stent, stent related symptoms or febrile UTIs. Cranberry extract may reduce the colonization of urinary tract, but its clinical significance needs further evaluation.

Temporary Trans-gastric Stent Deployment Over a 20 French Gastrostomy for Single-Stage Endoscopic Retrograde Cholangiopancreatography After Gastric Bypass.

Treatment of pancreato-biliary disorders after gastric bypass is challenging due to altered anatomy. Several techniques have been proposed to overcome this condition; however, none has emerged as the gold standard treatment. Furthermore, a decision-making algorithm evaluating when and why apply one technique over another is still lacking. To describe a novel trans-gastric approach to allow endoscopic retrograde cholangiopancreatography (ERCP) in Roux-en-Y gastric bypass (RYGB) anatomy soon after prior laparoscopic cholecystectomy (LC) and to propose a decision-making algorithm for selection of the most suitable technique according a tailored approach. Private hospital. Between January and March 2020, patients with Roux-en-Y gastric bypass anatomy referred to our tertiary center to undergo ERCP after recent laparoscopic cholecystectomy were retrospectively evaluated. A 20 french (Fr) gastrostomy was performed during cholecystectomy. A single-stage ERCP was carried out by means of temporary trans-gastric stent deployment over a 20 Fr gastrostomy. A total of 5 patients (mean age 41; mean body mass index 48.3) were enrolled. ERCP was performed after an average of 2days from surgery. Technical and clinical success was achieved in 100%. No adverse events occurred. Spontaneous closure of the gastrostomy after its bedside removal was observed in all cases. Our approach allows to perform a single-stage ERCP in RYGB patients, early after LC, with no need of any other re-interventions. Any surgeon facing unexpected biliary disorders, during LC, can easily perform a 20 Fr gastrostomy thus allowing the patient to undergo early ERCP without any delay.

V081 - Acute or chronic urine retention in males: A new temporary prostatic stent as an alternative to Foley catheter. A prospective non randomized study: 84 cases in 3 centers

V081 - Acute or chronic urine retention in males: A new temporary prostatic stent as an alternative to Foley catheter. A prospective non randomized study: 84 cases in 3 centers

649 - A new temporary prostatic stent to replace the Foley catheter in men with acute or chronic urinary retention: First 84 cases

649 - A new temporary prostatic stent to replace the Foley catheter in men with acute or chronic urinary retention: First 84 cases

Su1556 FEASIBILITY AND SAFETY STUDY OF A TEMPORARY BILIARY STENT FOR PROPHYLAXIS OF POST-ERCP CHOLANGITIS AFTER STONE REMOVAL

Endoscopic treatment of common bile duct stone is usually performed through the major papilla. Despite sphincteroplasty through EST or endoscopic papillary large balloon dilatation (EPLBD), edema of papilla is common after treatment, that may induce cholangitis with cholestasis (post-ERCP cholangitis: PEC). Although few cases of post-ERCP cholangitis progress to severe cholangitis, it can cause prolongation of hospital stay. To avoid this complication, biliary decompression is sometimes necessary in addition to stone removal. In such a case, ENBD or biliary stent are employed, that causes discomfort to the patient, or that requires another endoscopic session to remove the inserted stent. This retrospective study evaluates prophylactic effect of a temporary biliary stent to prevent PEC which dislodges after commencement of oral intake. Between April 2011 and May 2017, endoscopic treatment of common bile duct stones was performed on 2055 naive cases in our hospital. Among them, temporary biliary stents were employed in 190 patients in the first session. To select the patients to compare the feasibility and safety of a temporary stent between stent group and non-stent group in a reduced bias condition, propensity score matching was introduced. As a temporary biliary stent, we used 5Fr.-5cm Geenen type stent (COOK), which has a flap on only one side. After complete stone removal which was checked by balloon occlusion cholangiogram, the deployment of a temporary was decided within operator’s discretion. The PEC was defined as oral intake delay which was decided by fever and abdominal pain with abnormal liver function test. The severity of PEC was classified according to Cotton’s criteria. The dislodgement of deployed stent was confirmed by an abdominal X-ray after oral intake. Other adverse events including post-ERCP pancreatitis were also evaluated. A total of 72 pairs of patients were selected by propensity score matching. The incident rate of PEC in stent group was significantly lower than non-stent group (1.4% vs 11.1%, p=0.033). In all cases, severity of PEC was mild or moderate. The length of hospital stay in stent group were significantly shorter than in non-stent group (6.5 days vs 8.3 days, p=0.038). The rate of PEP was 7% in stent group and 5% in non-stent group (NS; p=0.83). In 3 cases (4%) of stent group, stent retention in CBD was observed, which was successfully removed endoscopically. No other severe adverse event such as perforation of retained stent was observed. Temporary biliary stents are suggested to have preventive effects of post-ERCP cholangitis and shorten hospitalization.

Sa1313 ANALYSIS OF SAFETY AND EFFICACY OF PERORAL ENDOSCOPIC MYOTOMY FOR ACHALASIA: A SINGLE-CENTER EXPERIENCE WITH MID-TERM FOLLOW-UP

Peroral endoscopic myotomy (POEM) has been introduced as a new effective therapeutic option for achalasia. This abstract illustrates our experience with POEM in a large single-center series of achalasia patients with mid-term follow-up. A retrospective review was conducted that included all consecutive patients with achalasia who underwent POEM between January 2016 to December 2018 in a tertiary care center. The primary outcome was clinical response, defined as an Eckardt score lower than 3. Secondary outcomes were procedure-related adverse events (graded according to the ASGE lexicon's severity grading system) and incidence of postoperative gastroesophageal reflux disease. A total of 206 patients (mean age 40.6 years, 94 males) underwent POEM for the treatment of achalasia (35 type I, 137 type II, 34 unspecified). Of these, 40 (19.4%) had received previous treatment for achalasia before POEM, including 27 pneumatic dilation, 8 prior POEM, 3 Heller myotomy, 1 botulinum toxin injection and 1 temporary esophageal stenting. Technical success was achieved in all patients. Posterior myotomy was performed in 70.9% of patients. Adverse events occurred in 20 (9.7%) patients. There were 9 inadverted mucosotomies, 5 pneumonia, 3 cardiac arrhythmia, 2 symptomatic pneumothorax requiring needle decompression, 1 pleural effusion requiring chest tube insertion. Fifteen adverse events were grade as mild, 5 moderate, and none severe. Among 185 patients with median follow-up period of 24 months (IQR 12.0-29.3), clinical success was achieved in 87.0% of patients, and Eckardt scores improved from pre-operative 6.4±1.9 to post-operative 1.4±1.6 (P <0.001). There were no significant differences in the success rate among the achalasia subtypes (P =0.947). Postoperative upper endoscopy revealed esophagitis in 19.5% of patients (5 LA grade A, 12 LA grade B), while 11.9% of patients had post-operative symptoms suggestive of gastroesophageal reflux (GerdQ >7). The present large series add to the evidence that POEM is a safe and effective treatment for achalasia patients, resulting in mid-term symptom relieved in nearly 90% of patients without severe adverse events.

Effect of over/under-expanding on the mechanical behavior in provisional stenting using bioresorbable scaffold

The purpose of this study is to contribute to the design and development by analyzing the expected mechanical behavior of bioresorbable scaffolds. Bioresorbable scaffolds are a type of medical device ‘stent’ that treats heart disease by physically removing plaque inside the coronary arteries. Unlike conventional metal-based stents, bioresorbable scaffolds are manufactured using polymeric materials that achieve dissolution properties within 1-2 years in vivo through hydrolysis with blood. Thus, bioresorbable scaffolds have the advantage of reducing postoperative side effects. However, due to the mechanical properties of the polymeric materials used, bioresorbable scaffolds are currently only applied to simple lesions. In particular, for branched lesions that separate from one main vessel into two branched vessels, the stenting procedures are still being studied through various clinical trials, but there are not many reports of studies and results through interpretation. A provisional stent method of placing a single stent in the blood vessel is commonly used to treat branched lesions. Since the diameter of the blood vessel before and after the branching is different, the selection of the stent diameter is applied as the first step before the stent operation. Conventional metal-based stent operations do not require this consideration, but it is needed for bioresorbable scaffolds due to the low tensile strength of the polymeric material. In this study, temporary stents with two different diameter bioresorbable scaffolds corresponding to the diameter of the main vessel at both ends were evaluated using the calculation method. In this study, these two stents with different diameters were compared in terms of device failure and damage to the inner wall of the blood vessel.

Novel Treatment Strategy for Management of Traumatic Bulbar Urethral Rupture Using Temporary Urethral Stent after Primary Realignment; Retrospective Comparison between Thermo-Expandable Urethral Stent and Self-Expandable Polymer-Coated Urethral Stent.

A variety of retrievable and other types of temporarily placed stents are currently being used. However, only a few studies have considered primary endoscopic realignment with temporary urethral stent insertion in the event of traumatic bulbar urethral injury. We aimed to compare the clinical effectiveness and complications between thermo-expandable urethral stents and polymer-coated bulbar urethral stents (BUSs) for the treatment of traumatic bulbar urethral strictures. Between September 2011 and March 2018, 30 patients who had been diagnosed with complete bulbar urethral rupture following blunt trauma underwent temporary urethral stent placement after primary realignment. Thermo-expandable nickel-titanium alloy urethral stents were placed for 15 patients (group M), and retrievable self-expandable polymer-coated BUSs were placed for another 15 patients (group A). All stents were removed within 6 months after placement. The complications and maintained patency rates were compared between the two groups. The mean stent indwelling period was 5.0 ± 2.5 months in group M and 4.9 ± 4.0 months in group A. Both groups maintained high patency rates (Group M 12/15 (80.0%) and group A 13/15 (86.7%)). Five patients who developed urethral stricture underwent direct visual internal urethrotomy (DVIU), and no patients required repeat DVIU or open surgical urethroplasty. Both groups maintained the mean maximal urinary flow rate (Qmax) at 12 months after stent removal. Discomfort (46.7% vs. 6.7%), granulation tissue formation (73.3% vs. 26.7%) and post-void dribbling (80.0% vs. 20.0%) were more frequent in group M than in group A (p = 0.013, p = 0.011 and p = 0.001, respectively). In conclusion, both stents were effective for managing traumatic complete bulbar urethral rupture after primary realignment. However, the thermo-expandable urethral stents had a higher complication rate while the stent was in situ than the BUSs.

Correction: Factors associated with complete clearance of difficult common bile duct stones after temporary biliary stenting followed by a second ERCP: a multicenter, retrospective, cohort study.

Background Although temporary endoscopic biliary stenting is considered effective for difficult common bile duct (CBD) stones, few studies have investigated the optimal conditions for complete stone clearance at the second endoscopic retrograde cholangiopancreatography (ERCP) after temporary biliary stenting. We aimed to evaluate factors associated with complete clearance. Methods Patients with difficult CBD stones (a large [≥ 20 mm] or multiple [≥ 3 sized ≥ 15 mm] CBD stones) were retrospectively enrolled from three institutions. Patients who underwent temporary biliary stenting at the first ERCP were analyzed. Double-pigtail plastic stents (7 or 10 Fr) were placed with the proximal ends above the stones. Complete clearance rate and stone size reduction at the second ERCP, and factors associated with complete clearance were evaluated using univariate and multivariate analyses. Results 85 patients were enrolled (mean age 74.5 years [SD 11.3]; 47 women). Stone size and CBD diameter significantly decreased during the interval. The overall complete stone clearance rate was 64.7 % (55/85) at the second ERCP. The mean stone size reduction was 5.6 mm (SD 6.8). In multivariate analysis, complete clearance rate was significantly lower in male patients, in patients aged > 80 years, and in stones > 25 mm initially, but was significantly higher when 7-Fr stents were placed and stone size was reduced by > 5 mm. Conclusion Use of 7-Fr rather than 10-Fr plastic stents was beneficial for complete clearance of difficult CBD stones after temporary biliary stenting; older male patients as well as patients with initial stones > 25 mm had a lower clearance rate.

V08-01 ACUTE OR CHRONIC URINE RETENTION IN MALES: A NEW TEMPORARY PROSTATIC STENT AS AN ALTERNATIVE TO FOLEY CATHETER. A PROSPECTIVE NON RANDOMIZED STUDY: 84 CASES IN 3 CENTERS

INTRODUCTION AND OBJECTIVE:A prospective non randomized study was conducted in 3 centers to evaluate 1: the feasibility of the insertion of a single size temporary prostatic stent under local anest...

PD41-06 LONG-TERM OUTCOMES OF LASER INCISION AND KENALOG INJECTION FOR THE MANAGEMENT OF URETEROENTERIC ANASTOMOTIC STRICTURES

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II (PD41)1 Apr 2020PD41-06 LONG-TERM OUTCOMES OF LASER INCISION AND KENALOG INJECTION FOR THE MANAGEMENT OF URETEROENTERIC ANASTOMOTIC STRICTURES Andrew B. Katims*, Beth T. Edelblute, Andrew W. Tam, Anna M. Zampini, Reza Mehrazin, and Mantu Gupta Andrew B. Katims*Andrew B. Katims* More articles by this author , Beth T. EdelbluteBeth T. Edelblute More articles by this author , Andrew W. TamAndrew W. Tam More articles by this author , Anna M. ZampiniAnna M. Zampini More articles by this author , Reza MehrazinReza Mehrazin More articles by this author , and Mantu GuptaMantu Gupta More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000921.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Benign ureteroenteric anastomotic stricture (UEAS) is a common postoperative complication after urinary diversion with an incidence of 3-10%. The gold standard of management is ureteral reimplantation, but due to the associated morbidity, endoscopic repair is an attractive management option. Minimally invasive approaches, including balloon dilatation, endoureterotomy, or metal stenting, have been investigated in multiple short-term studies. However, there is a paucity of long-term data in the current literature after endoscopic UEAS treatment. Our objective is to report long-term follow up of our technique for endoscopically managing UEAS after cystectomy. METHODS: Patients with endoscopically managed benign UEAS after cystectomy were included regardless of the type of enteric urinary diversion. The patients were treated between 2012 and 2019. Endoscopic intervention entailed flexible ureteroscopy with biopsy followed by laser incision of the stricture and of periureteral and perileal tissues 1 cm below and 1 cm above the stricture into fat. Kenalog injection was then performed, followed by balloon dilation of the incised area to 24Fr to assure no residual strands, and to ingrain the steroid into the incised area. The procedure was concluded by placement of parallel or solitary stents for 6 weeks. Patients were followed with CT scans at three months and one year after surgery, and renal ultrasound at six and nine months, and then annually. RESULTS: Twenty two patients, and a total of 26 UEAS were treated. Urinary diversion included ileal conduit (n=12), neobladder (n=8), and Indiana pouch (n=2). Twenty patients had no recurrence of stricture, including three who had bilateral disease, yielding an overall success rate of 88.5%. Both patients, one with bilateral disease, with recurrence had evidence of stricture within three months of their endoscopic surgery. Follow-up ranged from two to 96 months, with a median of 33.5 months. CONCLUSIONS: Patients treated endoscopically for UEAS have been shown to have acceptable short-term success with less morbidity when compared to ureteral reimplantation. Our technique of laser incision, Kenalog injection, balloon dilation, and temporary stent placement has a cure rate of nearly 90% and is unique in that long-term data confirms the durability of this endoscopic procedure. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e823-e823 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew B. Katims* More articles by this author Beth T. Edelblute More articles by this author Andrew W. Tam More articles by this author Anna M. Zampini More articles by this author Reza Mehrazin More articles by this author Mantu Gupta More articles by this author Expand All Advertisement PDF downloadLoading ...