Explore the vast range of titles available.

Posterior urethral stricture is a severe disease in urology, and end-to-end urethral anastomosis remains the gold standard treatment. The surgical outcome not only depends on meticulous intraoperative management but also on postoperative care. Key aspects of postoperative care include stable compression bandaging, prevention of skin tension and allergic blistering, and preventing penile from erection. We have produced a multifunctional protective pant that is expected to prove its effectiveness through a randomized controlled study. This study included 50 patients who were divided into an experimental group and a control group. The patients in the experimental group wore the protective pants immediately after surgery. On the basis of routine care in the control group, health education and guidance for patients and family members on wearing protective pants were added. During the postoperative period until discharge, we observed the occurrence of wound bleeding, abnormal body temperature, and evaluated patient infection status based on results such as blood routine and procalcitonin. A numerical scoring table was used for pain assessment during the three days and nine shifts handover of patients. Patient feedback during pants usage was obtained through a self-assessment questionnaire two months after surgery. On the second day after surgery, the incidence of scrotum oedema in the experimental group was significantly lower than that in the control group, with a statistically significant difference (P < 0.05). Within five days after surgery, the experimental group had a significantly lower incidence of wound bleeding, skin allergic blisters and erectile pain compared to the control group, with a statistically significant difference (P < 0.05). The use of the protective pants effectively reduced postoperative complications during the perioperative period, and significantly improving surgical success rates and patient satisfaction.

Reducing the risk of urethral strictures after transurethral surgery for patients with bladder cancer requires effective strategies. We compared the clinical outcomes of a novel drug-injectable urethral catheter set (NIUS) with hyaluronic acid (HA) with those of the conventional intraurethral HA injection method. This six-center, prospective, randomized, single-blind trial included 192 male patients aged ≥ 20 years scheduled to undergo transurethral surgery. The primary outcome was patient-reported satisfaction. Secondary outcomes were patient-reported pain intensity, clinician-reported convenience, and urethral strictures. Cystourethroscopy was performed under direct visualization. Outcomes of the experimental (NIUS with HA) and control (HA) groups were compared using the chi-square test and t-test. The post-transurethral surgery rate was significantly higher in the experimental group than in the control group ( p  < 0.001). Overall, 40% and 21.7% of patients in the experimental and control groups, respectively, were very satisfied ( p  < 0.001). The experimental group had lower postoperative pain intensity scores ( p  < 0.001), higher clinician-reported convenience scores ( p  < 0.001), and fewer urethral strictures within 3 months postoperatively ( p  < 0.001) than the control group. The NIUS with HA after transurethral surgery significantly enhanced patient satisfaction, reduced pain, improved clinician convenience, and was associated with a reduction in grade 1 urethral strictures. Thus, NIUS with HA enhances post-surgery outcomes through improved patient satisfaction and reduced urethral strictures. Trial registration : Cris.nih.go.kr (KCT0007010).

Radiation is a common treatment modality for pelvic malignancies. While it can be effective at cancer control, downstream effects can manifest months to years after treatment, leaving patients with significant morbidity. Within urology, a particularly difficult post-radiation consequence is urinary tract stricture, either of the urethra, bladder neck, or ureter. In this review, we will discuss the mechanism of radiation damage and treatment options for these potentially devastating urinary sequelae.

Certain biliary or pancreatic duct strictures can be crossed with a guidewire but remain impassable by standard dilation devices. Alternative strategies are sometimes required, such as drilling into the stricture with a cystotome, a 6Fr wire-guided electrocautery catheter. Data on the efficacy and safety of this rescue technique are scarce. We conducted a systematic literature review complemented by our single-center experience using a cystotome for unpassable biliopancreatic strictures. A systematic review of PubMed, Embase, Google Scholar, and Cochrane library was performed, including studies using a cystotome for biliary or pancreatic strictures that could not be dilated with standard accessories. Alternative devices (e.g., Soehendra) were excluded. Primary outcomes were the combination of technical success (ability to traverse the stricture and deploy a stent) and safety (absence of procedure-related adverse event). Clinical success (short- and long-term) were collected if available. Our review was supplemented with consecutive cases performed at Beaujon Hospital (Clichy, France) from 2020 to 2025. A total of 102 patients were included (93 patients from 9 studies and 9 from our center). The primary composite outcome, combining technical success and safety, was achieved in 90.2% of patients. Technical success was 100% (102/102), with clinical success reported in 94% (84/89). Cystotome-related mild adverse events occurred in 9.8% of patients. Cystotome-assisted electrosurgical drilling seems to be technically reliable and effective for complex biliopancreatic strictures that are resistant to standard dilation. This comprehensive study could encourage to integrate the cystotome in the endoscopists' endoscopic retrograde cholangiopancreatography toolbox.

Background This paper proposes a novel perspective on the value of qualitative research for improving trial design and optimising recruitment. We report findings from a qualitative study set within the OPEN trial, a surgical randomised controlled trial (RCT) comparing two interventions for recurrent bulbar urethral stricture, a common cause of urinary problems in men. Methods Interviews were conducted with men meeting trial eligibility criteria ( n  = 19) to explore reasons for accepting or declining participation and with operating urologists ( n  = 15) to explore trial acceptability. Results Patients expressed various preferences and understood these in the context of relative severity and tolerability of their symptoms. Accounts suggest a common trajectory of worsening symptoms with a particular window within which either treatment arm would be considered acceptable. Interviews with clinician recruiters found that uncertainty varied between general and specialist sites, which reflect clinicians’ relative exposure to different proportions of the patient population. Conclusion Recruitment post referral, at specialist sites, was challenging due to patient (and clinician) expectations. Trial design, particularly where there are fixed points for recruitment along the care pathway, can enable or constrain the possibilities for effective accrual depending on how it aligns with the optimum point of patient equipoise. Qualitative recruitment investigations, often focussed on information provision and patient engagement, may also look to better understand the target patient population in order to optimise the point at which patients are approached. Trial registration ISRCTN Registry, ISRCTN98009168 . Registered on 29 November 2012.

Urethral stricture secondary to urethral injury, afflicting both patients and urologists, is initiated by excessive deposition of extracellular matrix in the submucosal and periurethral tissues. Although various anti-fibrotic drugs have been applied to urethral stricture by irrigation or submucosal injection, their clinical feasibility and effectiveness are limited. Here, to target the pathological state of the extracellular matrix, we design a protein-based nanofilm-controlled drug delivery system and assemble it on the catheter. This approach, which integrates excellent anti-biofilm properties with stable and controlled drug delivery for tens of days in one step, ensures optimal efficacy and negligible side effects while preventing biofilm-related infections. In a rabbit model of urethral injury, the anti-fibrotic catheter maintains extracellular matrix homeostasis by reducing fibroblast-derived collagen production and enhancing metalloproteinase 1-induced collagen degradation, resulting in a greater improvement in lumen stenosis than other topical therapies for urethral stricture prevention. Such facilely fabricated biocompatible coating with antibacterial contamination and sustained-drug-release functionality could not only benefit populations at high risk of urethral stricture but also serve as an advanced paradigm for a range of biomedical applications. Various anti-fibrotic drugs have been applied to urethral stricture by irrigation or submucosal injection, but their clinical feasibility and effectiveness are limited. Here, the authors design a protein-based nanofilm-controlled drug delivery system with anti-biofilm properties that can be assembled on a catheter.

IntroductionIn patients with benign and refractory esophageal strictures (BES), repeating initial dilations in short intervals could be recommended, but little data are available to validate this strategy. Our aim was to evaluate long-term results of a scheduled program of repeated and sustained esophageal dilations in patients with refractory strictures.MethodsPatients with BES requiring five or more dilations were retrospectively included and divided in two groups for analysis: a SCHEDULED group (SDG) where patients were systematically rescheduled for the 5 first dilations; ON-DEMAND group (ODG) where patients were dilated only in case of recurrence of the dysphagia. Comparison between SDG and ODG was done with a 1:1 matching analysis and etiology of stricture. Clinical success was defined as the absence of dysphagia for more than a year.Results39 patients with refractory BES were included with post-operative stenosis in 51.2% and post-caustic injury 28.2%; 10 were in SDG and 29 in ODG. In overall analysis (39 patients), the follow-up was 64.4 ± 32 months, success rate was 79.5% and duration of treatment was 27.3 ± 20 months, and mean number of dilations was 11.7 per patient. The need for dilations decreased significantly after 18 months of treatment with an average of 0.56 dilations per semester. Self-expandable metallic stent insertion was associated with an increased rate of complications (5.9% vs 59.1% p = 0.001). In matched analysis (10 ODG vs 10 SDG patients), the duration of treatment was lower in SDG (18.8 vs 41.4 months, p = 0,032) with a higher probability of remission (survival analysis, Log-rank: p = 0,019) and the success rate did not differ between ODG and SDG patients (80% vs 90%; NS).ConclusionOverall, long-term esophageal dilations resulted in a 79.5% success rate and the need for further dilatations decreased significantly in both groups after 18-month follow-up. A scheduled dilation program was associated with a higher probability of final success and lower treatment duration.

Introduction and objectivesThis systematic review aims to evaluate the incidence and influencing factors of urethral stricture (US) in relation to different BPH endoscopic techniques.Materials and methodsWe performed a systematic literature review using MEDLINE, EMBASE, and Cochrane Central Controlled Register of Trials. The incidence of US was estimated through comparative studies between different endoscopic techniques. Patients were assigned into groups according to the type of surgery (enucleation, ablation and resection group). Incidences of US were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and reported as Risk Ratio (RR), 95% Confidence Intervals (CI), and p-values.ResultsA total of 80 studies were included for meta-analysis. The pooled incidence of US was 1.7% after enucleation, 2.1% after ablation, 3.8% after monopolar (M)-TURP and 2.1% after bipolar (B)-TURP. The incidence of US was significantly lower after Enucleation than after TURP (RR 0.58 95% CI 0.39–0.84, p = 0.004). US incidence was lower for Ablation procedures than TURP, but the difference did not reach significance (RR 0.79 95% CI 0.61–1.3, p = 0.08). However, this was significant in the subgroup of M-TURP studies (RR 0.67, 95% CI, 0.49–0.91, p = 0.01). Sub-analysis showed that the risk of US was significantly lower after Enucleation than after TURP within 12 months after surgery (RR 0.51 95% CI 0.33–0.81, p = 0.004).ConclusionThe study shows an increased incidence of US after TURP compared to enucleation and ablation procedures. The main factors related to increased US incidence are the use of monopolar energy, instrument caliber and duration of postoperative catheterization.

Purpose To determine the prevalence of concomitant squamous metaplasia (SM), the initial histological change from normal urethra to urethral stricture, in bulbar urethral strictures and to investigate the associated clinical factors. Methods A retrospective review was conducted on 165 male patients with bulbar urethral strictures who underwent excision and primary anastomosis (EPA) between 2010 and 2020, for whom complete clinical data and excised urethral specimens were available. An experienced pathologist histologically evaluated concomitant SM in paraffin sections of the proximal end of the excised urethra blinded to the clinical data. Disease duration was calculated as the period from the initial diagnosis of urethral stricture to the date of EPA. The association between concomitant SM and clinical background was investigated. Results SM was identified in 86 (52.1%) patients. The median disease duration in patients with SM (38 months) was significantly longer than that in patients without SM (9 months, p < 0.0001). In multivariate analysis, the longer disease duration, non-traumatic stricture etiology, and failure to maintain urethral rest with urinary diversion via a suprapubic tube for more than 90 days were independent factors predicting concomitant SM. No significant difference was observed in success rates of EPA between patients with SM (93.2%) and those without SM (97.5%, p = 0.18). Conclusions Reconstructive urologists need to be aware that concomitant SM is frequent in patients with bulbar urethral stricture, especially in those with long disease duration and those who were voiding volitionally during the period of urethral rest.