Treatment Of Strictures Research Articles

Small Balloon Dilation Versus Bougie Dilation Versus Large Balloon Dilation for the Treatment of Benign Esophageal Strictures in Adult Patients.

Small Balloon Dilation Versus Bougie Dilation Versus Large Balloon Dilation for the Treatment of Benign Esophageal Strictures in Adult Patients.

Chinese patent medicine: Opening new perspectives for treatment of post-endoscopic submucosal dissection esophageal stricture in esophageal cancer patients.

Endoscopic submucosal dissection (ESD) is an effective technique for treating early esophageal cancer, and the prevention of postoperative esophageal stricture has emerged as a significant research topic. Zhou et al utilized an experimental minipig model to demonstrate that Kangfuxin (KFX) can improve postoperative esophageal stricture following ESD by inhibiting transforming growth factor-β1-driven fibrosis and the downstream fibrotic mediators Smad2/3. In this letter, we primarily discuss recent advancements in the treatment of esophageal stricture, the clinical applications of KFX, and the mechanisms involved in alleviating postoperative esophageal stricture, aiming to provide insights for advancing clinical practice and research in esophageal stricture after ESD.

Endourological treatment of ureteral strictures with the use of self-expanding stents: is it possible to completely cure the stricture endoscopically? A report on the experience with implantation of 35 stents with a two-year follow-up period; a retrospective study

BackgroundThe current results of endoscopic treatment of ureteral strictures are characterized by very divergent treatment results, which is due to a wide range of criteria for including patients in the analyses and different definitions of effective treatment. In this retrospect study we wanted to introduce a possibility of curing ureteral strictures depending on their type and degree with the use of self-expanding ureteral stents (SUS).Methods33 patients with ureteral strictures received endourological treatment with the use of Allium® SUS (2 patients with SUS placed on both sides). Patients were divided into 2 groups: patients with uncomplicated strictures (Grp 1) and patients with complicated strictures (Grp 2). Uncomplicated stricture was defined as a single stricture below 2 cm. A complicated stricture was defined as a stricture over 2 cm and/or multiple strictures. The follow-up time was 24 months. All patients were scheduled for renoscintigraphy during the treatment. A full therapeutic success was defined as no tight stenosis in renoscintigraphic furosemide test after SUS explantation.ResultsIn Grp 1, full therapeutic success was achieved in 80% of patients, which was statistically significant (p < 0.001). Serious complications (Clavien-Dindo > 3a) occurred significantly more often in Grp 2 (p = 0.046). Renal outflow during stenting was present in 70% of the patients in Grp 2.ConclusionsA full therapeutic success of endoscopic, SUS-assisted treatment can be considered among patients with short, single ureteral stricture. In long and/or multiple strictures, SUS can be used as drainage element, but full recovery of the stricture is unlikely.

Post-living donor liver transplant biliary strictures: prevalence, predictors, and long-term outcomes in a retrospective study.

Post-liver transplant biliary strictures are a common cause of morbidity among patients who have undergone living donor liver transplantation (LDLT). Limited data are available concerning the response rates to various treatment modalities and the long-term outcomes for these individuals. This study was a retrospective analysis of a prospectively collected database, including adult patients aged 18 years or older who underwent LDLT between 2006 and 2022. Between 2006 and 2022, a total of 3,550 patients underwent liver transplantation. After applying exclusion criteria, 2,956 patients were included in the analysis. During the study period, 344 patients (11.6%) developed biliary strictures. Of these, 77.0% underwent endoscopic retrograde cholangiopancreatography as the primary treatment for biliary strictures, while the remainder received percutaneous transhepatic biliary drainage. Identified risk factors for post-liver transplant biliary strictures included the presence of multiple biliary anastomoses, bile leak, and older donor and recipient ages. The overall graft and patient survival rates were comparable between patients with and without biliary strictures, at both 1 year (93.0% vs. 96.3%) and 5 years (82.3% vs. 79.2%). Biliary strictures are observed in approximately 11% of recipients following LDLT. While the presence of biliary strictures is associated with increased morbidity, it does not significantly impact patient survival.

One-stage urethroplasty using a combination of buccal mucosa graft and Q penile skin flap for a complicated urethral stricture: A challenging case report.

Strictures of the male urethra are common, often caused by trauma or occur idiopathically. The primary clinical symptoms include chronic obstructive voiding issues, and some patients may experience sexual dysfunction. Treatment choices mainly depend on the stricture's location and length. A 37-year-old man visited the urology department with lower urinary tract symptoms and recurrent urinary tract infections. He had a 5 cm urethral stricture previously treated with urethroplasty, which was unsuccessful. A retrograde urethrography revealed the stricture, an extra-anatomical bypass, and a diverticulum. A second urethroplasty was performed, using a combination of a buccal mucosa graft and a penile skin flap. Postoperative follow-up indicated improvement in the patient's voiding symptoms. A retrograde urethrography was done 3 months after the procedure showing a well-patent urethra with no complications. The key factors in deciding the treatment for urethral strictures are their location and length. Both grafts and flaps are effective for urethroplasties. However, complex long strictures with damaged urethral plates pose challenges for successful single-stage reconstruction. Combining a dorsal buccal mucosa graft to augment the urethral plate with a ventral onlay penile skin flap is a promising approach, leveraging the benefits of both tissue types. Combining grafts and flaps is advisable for reconstructing complicated urethral strictures with damaged urethral plates. Consulting a more experienced surgeon is recommended to minimize the risk of complications.

Evolution and innovation in urethroplasty: a comprehensive narrative review of graft types and surgical techniques.

Urethroplasty has evolved over last decades, with significant improvements in surgical techniques and graft types. In this narrative review, we aimed to explore the evolution of urethroplasty techniques for bulbar urethral strictures. To do this, the review is structured into three main sections: the Historical Background section highlights the seminal contribution from early pioneers to contemporary techniques, which re-gained momentum in reconstructive urology. Starting with the early techniques in the 19th and 20th centuries, we focused on the pioneering innovations of the 1990s, ultimately leading to the most recent tissue-preserving techniques. The second part presents a literature review comparing different graft types and critically evaluating surgical outcomes from multiple original articles and meta-analysis. Specifically, similar success rates were reported for oral and preputial grafts for the treatment of anterior urethral strictures, while long-term outcomes suggest graft deterioration over time. Furthermore, data on optimal surgical techniques remain limited. Lastly, Future Perspectives address ongoing innovations, including new graft and flap combinations for complex strictures, emphasizing the continuous refinement of less invasive, tissue-preserving techniques.

Endoscopic stricturotomy: a novel technique for the endoscopic treatment of dilatation-refractory oesophageal strictures

Endoscopic stricturotomy: a novel technique for the endoscopic treatment of dilatation-refractory oesophageal strictures

Abstract No. 585 Percutaneous Treatment of Bilioenteric Anastomotic Strictures: Comparison of Long-Term Outcomes Between Temporary Covered Stents and Balloon Dilation

Abstract No. 585 Percutaneous Treatment of Bilioenteric Anastomotic Strictures: Comparison of Long-Term Outcomes Between Temporary Covered Stents and Balloon Dilation

Comparison of endoscopic radial incision technique vs. endoscopic balloon dilation for the treatment of refractory esophageal anastomotic strictures

Comparison of endoscopic radial incision technique vs. endoscopic balloon dilation for the treatment of refractory esophageal anastomotic strictures

Erectile function in patients after urethral plastic surgery

Introduction. At present, the progress in reconstructive urology demonstrates high efficiency rates in treating urethral strictures (US), ensuring satisfactory urination parameters. Meanwhile, there is a need to maintain a high quality of life associated with male sexual function.Objective. To evaluate the erectile function in males suffering from US considering the presence of risk factors for erectile dysfunction (ED), characteristics of US and surgical techniques employed.Materials &amp; methods. The study involved 153 sexually active patients with US who underwent surgical treatment. The assessment of erectile function was carried out using the IIEF-5 questionnaire, while considering the presence of risk factors for ED in patients (age, smoking, coronary heart disease, arterial hypertension, type 2 diabetes mellitus), stricture parameters (primary/recurrent, length) and surgical technique (transecting and non-transecting techniques). Evaluation time points: baseline (before surgery), 3, 6, and 12 months after urethroplasty.Results. The mean age of the patients was 53.0 years, and their baseline erectile function scores were 19.0 points. Regardless of the parameters under study, a decline in erectile function was observed in all study groups by the 3-month follow-up, which regressed over the one-year follow-up period. The duration of recovery and severity of erectile dysfunction were associated with age, smoking, the presence of coronary heart disease and arterial hypertension, US length, and recurrent nature of strictures. No significant differences were found in erectile function indicators after surgery, depending on the grade of transection of the spongy body. According to multivariate analysis, predictors of ED development after surgery include age (adjusted odds ratio [AOR] 1.082; 95% confidence interval [CI] 1.038–1.127; p &lt; 0.001), arterial hypertension (AOR 4.608; 95% CI 1.089–19.511; p = 0.038), and baseline erectile function status (AOR 0.046; 95% CI 0.013–0.160; p &lt; 0.001). Conclusion. ED following surgical treatment of urethral strictures is predominantly transient, with regression observed by the 12-month follow-up period. The recovery of erectile function is adversely affected by advanced age, smoking, cardiovascular diseases, the length and recurrent nature of US.

Re: A New Technique for the Treatment of Ureteric Stricture After Kidney Transplantation.

Re: A New Technique for the Treatment of Ureteric Stricture After Kidney Transplantation.

Advances in Tissue Engineering for the Treatment of Urethral Stricture

Urethral stricture is a common disease of the urinary system, mainly caused by trauma, inflammation, iatrogenic injury and other factors, which can lead to dysuria, urinary retention and even renal function impairment, seriously affecting the quality of life of patients. Traditional treatments such as urethral dilatation and urethroplasty have limitations, including a high recurrence rate, many complications, and a lack of graft. Recent rapid development in tissue engineering techniques has provided a new direction for the repair of urethral strictures. This review summarizes the progress of tissue engineering in the treatment of urethral strictures, including the application of scaffold materials, seed cells, bioactive factors, and explores the challenges and prospects of future development.

The use of Triamcinolone Injection in treatment of refractory benign Esophageal Stricture in children

Objectives: To evaluate the efficacy of Intra-lesional triamcinolone injection in the management of refractory benign esophageal Stricture in children. Methods: Before endoscopic dilatation, triamcinolone acetate (40 mg/ml) was be applied in the first 5 dilations with an interval of one week between the first and second dilation and then every 2 weeks. Results: A total of 67 children with refractory benign esophageal stricture out of 183 children (36.6%) who presented with esophageal stricture were enrolled in the study, Cause of esophageal stricture was post-corrosive injury (n=59, 88.1%), with a smaller proportion attributed to post-TEF repair (n=8, 11.9%), There was a significant reduction in the number of dilatations required before and after the triamcinolone injections. The mean maximum dilation improved from 10.66 mm SG(Savary-Gilliard) before injections to 13.13 mm SG after injections, periodic dilatation index (PDI) showed significant reduction post-treatment. The mean PDI decreased from 1.07 to 0.27, There was a significant improvement in the grades of dysphagia, there was no significant changes in cortisone levels, ACTH (Adrenocorticotropic hormone) levels showed no significant change, there were no major complications of the procedure. Conclusion: findings suggest that intralesional triamcinolone injection is an effective and safe treatment option for refractory benign esophageal strictures in children.

Case series of small bowel adenocarcinoma associated with Crohn's disease.

Long-standing Crohn's disease (CD) is well known to be associated with gastrointestinal malignancies. Patients with CD have a higher risk of developing small bowel adenocarcinoma (SBA) compared to healthy individuals. However, CD-associated SBA is not as common as colorectal cancer. While patients with CD often present with complicated stricture lesions in the small intestine, it is difficult to confirm all lesions by endoscopy. There is still no consensus on the surgical treatment of small bowel strictures with suspected CD-associated SBA. We report a case of small bowel high-grade dysplasia and two cases with advanced SBA. Case 1 involved a 53-year-old man whose high-grade dysplastic lesion of the small intestine was discovered incidentally postoperatively and successfully resected curatively. Case 2 was that of a 60-year-old man and Case 3 involved a 69-year-old man. Both patients had multiple small bowel stenotic lesions and were diagnosed with advanced small bowel cancer during follow-up. In conclusion, for patients with long-standing Crohn's disease who are refractory to treatment or have stenotic lesions, surgical resection should be considered as a treatment option with CD-associated SBA in consideration.

Comparative study of holmium laser versus cold-knife optical internal urethrotomy in urethral stricture

Objective: One of the most difficult urological ailments is to cure the urethral stricture adequately. There are various methods employed for the treatment of urethral stricture. This analysis was conducted to compare the efficacy and safety of holmium laser versus cold-knife optical urethrotomy for operative time, complications, and recurrence. Methods: The study design is a comparative study. The study participants were enrolled after procuring voluntary informed consent. Fifty-six patients were included in the study from the Urology department Super Speciality Hospital, GMC, Jammu from 1 November 2017 to 31 October 2018 and were divided into Group 1 (holmium group) and Group 2 (cold-knife group). Patients were catheterised with 14 Fr Foley’s catheter after the procedure and the catheter was removed on the third postoperative day. Patients were followed for 6 months. At each follow-up physical examination and uroflowmetry were performed. On the 90th post-operative day, a retrograde urethrogram was performed. Results: Both the cold knife and holmium laser have been safe and effective in providing immediate relief to patients with single and short-segment (&lt; 1 cm long) urethral strictures. The cold knife offers a significant advance over the holmium laser in terms of the operative time, which was shorter in the cold-knife group. The success rates for laser and cold knife were similar. Conclusion: The success rates for laser and cold knife were very similar, with the groups having a similar trend in success rates at different follow-up time points. The present findings may benefit from long-term follow-up analysis. Level of evidence: 4

Triple Modality Triumph: Novel Endoscopic Treatment of Complex Ileorectal Anastomotic Stricture.

Triple Modality Triumph: Novel Endoscopic Treatment of Complex Ileorectal Anastomotic Stricture.

Bladder Mucosa Harvested with Holmium Laser for Treatment of Urethral Strictures: Does the Graft Have its Tissue Integrity Preserved?

The aim of this study is to evaluate the integrity and the microstructural characteristics of the bladder mucosa graft harvested using a minimally invasive technique with the Holmium laser (Ho-YAG) for the treatment of urethral stricture. We studied patients with urethral strictures greater than 2 cm, with a urethroplasty indication. The patients were submitted to urethroplasty with the dorsal onlay reconstruction by a single surgeon. After the urethral dissection we use the Ho-YAG laser with a 550µg end fire laser fiber to obtain a fragment of bladder mucosa for the graft confection. A fragment of the bladder mucosa was fixed in a 10% buffered formalin to HE and Masson's trichrome analysis for the tissue integrity. Five sections were stained, and five fields of each section were selected. We used the Image J software, version 1.46r, loaded with its own plug-in to determine tissue integrity. We studied 11 patients (Mean age= 47.64); 9 (81.8%) with bulbar stricture and 2 (18.2%) with penile stricture (mean size = 4.63mm). The mean of bladder graft size was 53.64mm and the meantime of harvesting was 47.63 minutes. The histological study of the bladder wall graft showed an organization in accordance with normal standards, with the presence of an intact urothelium in the bladder graft. The submucosal layer is preserved, joining the detrusor to the urothelium and the collagen and elastic fibers are well organized. The graft harvested from the bladder uroepithelium using Ho-YAG has its histological integrity preserved, which makes this technique a viable option for reconstructive surgery. However, more studies are needed to establish its long-term efficacy and safety of this new technique.

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

Internationally, there is a trend towards early urethroplasty for treatment of urethral stricture, as opposed to endoscopic management, which is associated with short-lived patency and frequent retreatments. The objective of this study was to compare the outcomes of urethral stricture management before and after gaining urethral reconstruction expertise through a fellowship programme. This was a retrospective case-control study that compared the characteristics, management, and outcomes of urethral stricture disease managed over two consecutive periods of time-pre-fellowship period (September 2016 to September 2019) and the post-fellowship period (October 2019 to September 2022). There were 37 patients in the pre-fellowship group and 30 patients in the post-fellowship group. Regarding treatment choice, the proportion of patients undergoing index urethroplasty significantly increased from 2.7% to 36.7% [odds ratio (OR) 18.9, 95% confidence interval (CI): 2.7 to 209.8, P<0.008], due to early recognition of strictures not amenable endoscopic treatment. Retreatment became less frequent post-fellowship (37.8% vs. 16.7%, OR 2.99, 95% CI: 1.6 to 5.9, P=0.001). Average number of procedures per patient also reduced (1.65±0.98 vs. 1.23±0.63, P=0.04). Also, there was a trend towards improved overall patency rate at 6-month in the post-fellowship period compared to the pre-fellowship group. This study has demonstrated that urethral reconstruction expertise was correlated to the increased exposure of urethral stricture patients to urethroplasty as a more efficacious procedure, and was associated with reduced retreatment rates. The expertise can bring cost benefits for patients and regional institutions.

Ten years' single surgeon experience of excision and primary anastomosis urethroplasty for traumatic urethral stricture: an analysis of risk factors for urethral stricture recurrence.

Excision and primary anastomosis (EPA) urethroplasty is the standard treatment for traumatic urethral strictures, but managingthem remains challenging for urologists. Identifying factors leading to EPA urethroplasty failure benefits both patients andsurgeons. This study aims to analyze risk factors for urethral stricture recurrence after one-year follow-up of EPA urethroplasty. Data on male patients undergoing EPA urethroplasty at the Urology Department of Saiful AnwarGeneral Hospital from January 2013 until December 2023 were prospectively recorded. Successful urethroplasty, defined as theabsence of additional treatment necessity, was assessed until 12 months follow-up. Demographic data, time to surgery, strictureetiology, comorbidities, prior urethral interventions, and operationsteps were recorded. Univariate and multivariate Cox regression analyses were performed using IBM SPSS Statisticsversion 21. Total 95 patients were observed, and 89 patients wereincluded, averaging 41.2 ± 15.59 years old. EPA urethroplasty succeeded in 91% of cases over a median follow-up of 16.3months. Pelvic fracture urethral injury (PFUI) was the predominant etiology in 74% of cases, with an average stricture lengthof 25.4 ± 16.3 mm. The average time to surgery was performed on average 6.67 ± 4.07 months after diagnosis. In univariateanalysis, body mass index (BMI), time to surgery, and stricture length were associated with urethral stricture recurrence.However, only time to surgery showed a significant association in multivariate analysis. Obesity, the length of the stricture, and delayed surgical intervention are associated with an increased risk of urethral stricture recurrence in patients following EPA. EPA urethroplasty demonstrates a high success rate in managing traumatic urethral strictures.

Efficacy of urethral suspension-assisted urethral anastomosis as a treatment for complex long-segment posterior urethral stricture.

To determine the clinical effects of urethral suspension-assisted urethral anastomosis on complex long-segment posterior urethral stricture and describe the technical aspects of this procedure. The clinical data for 24 patients who underwent urethral suspension-assisted urethral anastomosis for complex long-segment posterior urethral stricture between March 2021 and March 2024 were retrospectively analyzed. The surgical procedure comprises the following four steps: creation of an inverted Y-shaped incision in the perineum; mobilization of the urethra up to the penile-scrotal junction followed by dissection and separation of the septum of the corpus cavernosum; separation of the inferior pubic symphysis, excising a portion of the inferior pubic symphysis bone tissue and thoroughly clearing the scar tissue surrounding the proximal urethra; and suturing and suspension of the proximal urethra and surrounding tissues at the 2, 5, 7, and 10 o'clock positions, ensuring complete exposure of the proximal urethral mucosa and tension-free anastomosis between the proximal and distal urethra. The mean patient age was 46.7 years (range 27-64) and the median urethral stricture length was 5.1cm. The urethral catheter was removed 4 weeks postoperatively. The median follow-up duration was 13.6 months (4-32). Urinary flow remained unobstructed in 22 patients (91.7%), with an average maximum flow rate of 24.5ml/s (15.3-36.2). Urethral stricture recurred post-surgery in two patients, one of whom underwent successful repair with the same surgical procedure while the other achieved successful voiding after urethrotomy. Urethral suspension-assisted urethral anastomosis is an effective treatment for complex long-segment posterior urethral stricture. This technique allows for optimal exposure of the proximal urethral mucosa, reduces the distance between the proximal and distal urethra, simplifies surgical procedures, enables tension-free anastomosis between the proximal and distal urethra, and has a high success rate.