The Experts below are selected from a list of 303 Experts worldwide ranked by ideXlab platform
Rajiv K Singal - One of the best experts on this subject based on the ideXlab platform.
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holmium yag laser endoureterotomy for treatment of ureteral Stricture
Urology, 1997Co-Authors: Rajiv K Singal, John D Denstedt, Hassan Razvi, Samuel S ChunAbstract:Abstract Objectives Endourologic techniques ranging from balloon dilation to endoincision with electrocautery, cold knife, and lasers have been increasingly used in recent years for the treatment of ureteral Strictures. While the long-term results may not be as reliable or as durable as traditional reconstructive surgical techniques, they can be accomplished with much less morbidity. Recently, the holmium:yttrium-aluminum-garnet (YAG) laser, which possesses both cutting and coagulating properties, has been demonstrated to have many applications in urology. We report our experience with this laser in the endoscopic treatment of ureteral Strictures. Methods We reviewed the charts and follow-up history of 22 patients in whom the holmium:YAG laser was used to treat ureteral Strictures from a variety of causes and including those in ureteroenteric anastomoses. Strictures were either approached in a retrograde fashion with a 6.9F ureteroscope or antegrade with flexible instruments in the cases involving ureteroenteric Strictures. The only energy source employed was the laser, followed by balloon dilation. Indwelling stents were left in place for at least 4 weeks postoperatively and follow-up was obtained with radiographic imaging. Results A minimum 9-month follow-up was available for 18 patients. There were 5 patients who had developed recurrent Strictures and were therefore considered treatment failures. Each of these patients failed in less than 3 months and all had either lengthy or complex Strictures noted at the time of surgery. One patient was lost to follow-up and three recent patients have follow-up of 3 to 6 months showing no evidence of recurrent Stricture formation. Overall, 16 of 21 (76%) patients are clinically well with no evidence of Stricture recurrence. Conclusions Endoureterotomy for ureteral Stricture disease is a minimally invasive, less morbid, but ultimately less successful, alternative to open surgical reconstruction. Stricture length and etiology remain the most important determinants of success. The holmium:YAG laser, with its ability to precisely cut tissue and provide hemostasis and its multiuse potential and compatibility with small rigid and flexible endoscopic instruments, is an ideal tool for performing endoureterotomy.
John D Denstedt - One of the best experts on this subject based on the ideXlab platform.
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holmium yag laser endoureterotomy for treatment of ureteral Stricture
Urology, 1997Co-Authors: Rajiv K Singal, John D Denstedt, Hassan Razvi, Samuel S ChunAbstract:Abstract Objectives Endourologic techniques ranging from balloon dilation to endoincision with electrocautery, cold knife, and lasers have been increasingly used in recent years for the treatment of ureteral Strictures. While the long-term results may not be as reliable or as durable as traditional reconstructive surgical techniques, they can be accomplished with much less morbidity. Recently, the holmium:yttrium-aluminum-garnet (YAG) laser, which possesses both cutting and coagulating properties, has been demonstrated to have many applications in urology. We report our experience with this laser in the endoscopic treatment of ureteral Strictures. Methods We reviewed the charts and follow-up history of 22 patients in whom the holmium:YAG laser was used to treat ureteral Strictures from a variety of causes and including those in ureteroenteric anastomoses. Strictures were either approached in a retrograde fashion with a 6.9F ureteroscope or antegrade with flexible instruments in the cases involving ureteroenteric Strictures. The only energy source employed was the laser, followed by balloon dilation. Indwelling stents were left in place for at least 4 weeks postoperatively and follow-up was obtained with radiographic imaging. Results A minimum 9-month follow-up was available for 18 patients. There were 5 patients who had developed recurrent Strictures and were therefore considered treatment failures. Each of these patients failed in less than 3 months and all had either lengthy or complex Strictures noted at the time of surgery. One patient was lost to follow-up and three recent patients have follow-up of 3 to 6 months showing no evidence of recurrent Stricture formation. Overall, 16 of 21 (76%) patients are clinically well with no evidence of Stricture recurrence. Conclusions Endoureterotomy for ureteral Stricture disease is a minimally invasive, less morbid, but ultimately less successful, alternative to open surgical reconstruction. Stricture length and etiology remain the most important determinants of success. The holmium:YAG laser, with its ability to precisely cut tissue and provide hemostasis and its multiuse potential and compatibility with small rigid and flexible endoscopic instruments, is an ideal tool for performing endoureterotomy.
Hassan Razvi - One of the best experts on this subject based on the ideXlab platform.
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holmium yag laser endoureterotomy for treatment of ureteral Stricture
Urology, 1997Co-Authors: Rajiv K Singal, John D Denstedt, Hassan Razvi, Samuel S ChunAbstract:Abstract Objectives Endourologic techniques ranging from balloon dilation to endoincision with electrocautery, cold knife, and lasers have been increasingly used in recent years for the treatment of ureteral Strictures. While the long-term results may not be as reliable or as durable as traditional reconstructive surgical techniques, they can be accomplished with much less morbidity. Recently, the holmium:yttrium-aluminum-garnet (YAG) laser, which possesses both cutting and coagulating properties, has been demonstrated to have many applications in urology. We report our experience with this laser in the endoscopic treatment of ureteral Strictures. Methods We reviewed the charts and follow-up history of 22 patients in whom the holmium:YAG laser was used to treat ureteral Strictures from a variety of causes and including those in ureteroenteric anastomoses. Strictures were either approached in a retrograde fashion with a 6.9F ureteroscope or antegrade with flexible instruments in the cases involving ureteroenteric Strictures. The only energy source employed was the laser, followed by balloon dilation. Indwelling stents were left in place for at least 4 weeks postoperatively and follow-up was obtained with radiographic imaging. Results A minimum 9-month follow-up was available for 18 patients. There were 5 patients who had developed recurrent Strictures and were therefore considered treatment failures. Each of these patients failed in less than 3 months and all had either lengthy or complex Strictures noted at the time of surgery. One patient was lost to follow-up and three recent patients have follow-up of 3 to 6 months showing no evidence of recurrent Stricture formation. Overall, 16 of 21 (76%) patients are clinically well with no evidence of Stricture recurrence. Conclusions Endoureterotomy for ureteral Stricture disease is a minimally invasive, less morbid, but ultimately less successful, alternative to open surgical reconstruction. Stricture length and etiology remain the most important determinants of success. The holmium:YAG laser, with its ability to precisely cut tissue and provide hemostasis and its multiuse potential and compatibility with small rigid and flexible endoscopic instruments, is an ideal tool for performing endoureterotomy.
Samuel S Chun - One of the best experts on this subject based on the ideXlab platform.
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holmium yag laser endoureterotomy for treatment of ureteral Stricture
Urology, 1997Co-Authors: Rajiv K Singal, John D Denstedt, Hassan Razvi, Samuel S ChunAbstract:Abstract Objectives Endourologic techniques ranging from balloon dilation to endoincision with electrocautery, cold knife, and lasers have been increasingly used in recent years for the treatment of ureteral Strictures. While the long-term results may not be as reliable or as durable as traditional reconstructive surgical techniques, they can be accomplished with much less morbidity. Recently, the holmium:yttrium-aluminum-garnet (YAG) laser, which possesses both cutting and coagulating properties, has been demonstrated to have many applications in urology. We report our experience with this laser in the endoscopic treatment of ureteral Strictures. Methods We reviewed the charts and follow-up history of 22 patients in whom the holmium:YAG laser was used to treat ureteral Strictures from a variety of causes and including those in ureteroenteric anastomoses. Strictures were either approached in a retrograde fashion with a 6.9F ureteroscope or antegrade with flexible instruments in the cases involving ureteroenteric Strictures. The only energy source employed was the laser, followed by balloon dilation. Indwelling stents were left in place for at least 4 weeks postoperatively and follow-up was obtained with radiographic imaging. Results A minimum 9-month follow-up was available for 18 patients. There were 5 patients who had developed recurrent Strictures and were therefore considered treatment failures. Each of these patients failed in less than 3 months and all had either lengthy or complex Strictures noted at the time of surgery. One patient was lost to follow-up and three recent patients have follow-up of 3 to 6 months showing no evidence of recurrent Stricture formation. Overall, 16 of 21 (76%) patients are clinically well with no evidence of Stricture recurrence. Conclusions Endoureterotomy for ureteral Stricture disease is a minimally invasive, less morbid, but ultimately less successful, alternative to open surgical reconstruction. Stricture length and etiology remain the most important determinants of success. The holmium:YAG laser, with its ability to precisely cut tissue and provide hemostasis and its multiuse potential and compatibility with small rigid and flexible endoscopic instruments, is an ideal tool for performing endoureterotomy.
Alex J Vanni - One of the best experts on this subject based on the ideXlab platform.
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Management of Urethral Stricture and Bladder Neck Contracture Following Primary and Salvage Treatment of Prostate Cancer
Current Urology Reports, 2017Co-Authors: Brendan Michael Browne, Alex J VanniAbstract:Purpose of Review This article discusses the incidence, evaluation, and treatment of bladder outlet obstruction from urethral Stricture, vesicourethral anastomotic Stricture, and bladder neck contracture following primary and salvage treatment of prostate cancer. Recent Findings Rates of stenosis after prostate cancer treatment appear similar across all primary treatment modalities including radical prostatectomy, radiation therapy, cryoablation, and high-intensity focused ultrasound in contemporary series. Urethral dilation and urethrotomy continue to report moderate patency rates. Urethroplasty achieves high patency rates even for long Strictures, but more extensive reconstruction increases the risk of postoperative urinary incontinence. Recent AUA guidelines on urethral Strictures provide new recommendations for management of these patients. Summary All treatment options for prostate cancer carry a risk for bladder outlet obstruction, and intervention is often necessary to relieve long-lasting morbidity. Careful preoperative evaluation should be completed to assess location and extent of the Stricture in order to choose optimal therapy. Endoscopic treatments, open reconstruction, and urinary diversion all play a role in relief of stenosis depending on Stricture length, location, characteristics, and patient comorbidities.
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urethroplasty for high risk long segment urethral Strictures with ventral buccal mucosa graft and gracilis muscle flap
The Journal of Urology, 2014Co-Authors: Drew Palmer, Alex J Vanni, Leonard Zinman, Jill C BuckleyAbstract:Purpose: Long segment urethral Strictures with a compromised graft bed and poor vascular supply are unfit for standard repair and at high risk for recurrence. We assessed the success of urethral reconstruction in these patients with a ventral buccal mucosa graft and gracilis muscle flap.Materials and Methods: We retrospectively reviewed the records of 1,039 patients who underwent urethroplasty at Lahey Hospital and Medical Center between 1999 and 2014. We identified 20 patients who underwent urethroplasty with a ventral buccal mucosa graft and a gracilis muscle flap graft bed. Stricture recurrence was defined as the inability to pass a 16Fr cystoscope.Results: Mean Stricture length was 8.2 cm (range 3.5 to 15). Strictures were located in the posterior urethra with or without involvement of the bulbar urethra in 50% of cases, and in the bulbomembranous urethra in 35%, the bulbar urethra in 10% and the proximal pendulous urethra in 5%. Stricture etiology was radiation therapy in 45% of cases, followed by an...
