ABSTRACT Impaired wound healing in diabetes is closely associated with cellular ferroptosis. Microneedle‐assisted gas therapy exerts molecular regulation of ferroptosis, representing a promising approach for accelerating diabetic wound healing. To date, O 2 and H 2 gas therapies have consistently been conducted independently and have never been integrated into a single system. Whether and how their synergy might be realized remains a defining challenge. Herein, we propose a concept of integrated O 2 and H 2 gas therapy, demonstrated by fabricating a gas‐producing microneedle material. Platinum@MIL‐101(Fe)‐NH 2 @phosphotungstic acid (PMP) nanoparticles are synthesized as a visible light‐driven photocatalyst for H 2 and O 2 co‐evolution. The rational design of a spatially separated structure boosts their photocatalytic efficiency under physiological conditions. PMP nanoparticles are further incorporated with bilayer gelatin methacryloyl (GelMA)/PMP composite microneedles (denoted as GPM microneedles). The obtained GPM microneedles enable transdermal delivery of PMP nanoparticles for integrated O 2 and H 2 gas therapy, and demonstrate desirable biocompatibility and pro‐regenerative effects. The mechanism of integrated O 2 and H 2 gas therapy has been identified as a TNFAIP3/hnRNPA1 ubiquitination/ferroptosis signaling axis, establishing for the first time a direct link to ferroptosis. In conclusion, this study yields a transformative concept and a ferroptosis‐targeting microneedle material with well‐defined molecular mechanism for diabetic wound management.

Background and objective:Management of long proximal ureteral strictures remains a significant challenge. Posteriorly augmented anastomotic ureteroplasty with lingual mucosal onlay grafts (PAAU-LMG) is a novel technique used for treating obliterated or diseased ureteral segments. This study aims to evaluate the long-term effectiveness of PAAU-LMG in a multi-institutional cohort of patients with long, complex proximal ureteral strictures. Methods:This retrospective study involved data for 61 patients treated with PAAU-LMG at three centers between April 2017 and December 2024. Perioperative and follow-up data were collected. Surgical success is defined by the absence of clinical symptoms, no stricture on imaging, and no severe complications. A descriptive statistical analysis was performed. Key findings and limitations:Of the 61 patients, 18 underwent laparoscopic surgery and 43 underwent robotic surgery. PAAU-LMG was performed in 45 (73.77%) cases, 16 (26.23%) cases underwent PAAU-LMG with ureteral dorsal adventitia "fold" technique. The reconstructed ureter was covered with perirenal fat in four cases (6.56%) and with omentum in 57 cases (93.44%). The median (range) stricture length was 3.60 (1.50-9.00) cm, operative time was 140 (84-306) min, estimated blood loss was 50 (10-400) ml, and postoperative hospital stay was 6 (4-10) d. No open conversions and intraoperative complications occurred. At a median (range) follow-up of 32 (7-98) mo, the overall success rate was 100% (61/61). The main limitation is the lack of a control group. Conclusions and clinical implications:PAAU-LMG is a safe, effective, and feasible treatment for selected patients with long obliterated or diseased proximal ureteral strictures. Patient summary:We evaluated the long-term follow-up outcomes of posteriorly augmented anastomotic ureteroplasty with lingual mucosal onlay grafts (PAAU-LMG), in which the diseased ureter was excised and reanastomosed primarily on the dorsal side, and a lingual mucosal graft was placed on the ventral side. For patients with obliterated or diseased ureter stricture, PAAU-LMG is a safe and feasible alternative with satisfactory outcome.

Impaired wound healing in diabetes is closely associated with cellular ferroptosis. Microneedle-assisted gas therapy exerts molecular regulation of ferroptosis, representing a promising approach for accelerating diabetic wound healing. To date, O2 and H2 gas therapies have consistently been conducted independently and have never been integrated into a single system. Whether and how their synergy might be realized remains a defining challenge. Herein, we propose a concept of integrated O2 and H2 gas therapy, demonstrated by fabricating a gas-producing microneedle material. Platinum@MIL-101(Fe)-NH2@phosphotungstic acid (PMP) nanoparticles are synthesized as a visible light-driven photocatalyst for H2 and O2 co-evolution. The rational design of a spatially separated structure boosts their photocatalytic efficiency under physiological conditions. PMP nanoparticles are further incorporated with bilayer gelatin methacryloyl (GelMA)/PMP composite microneedles (denoted as GPM microneedles). The obtained GPM microneedles enable transdermal delivery of PMP nanoparticles for integrated O2 and H2 gas therapy, and demonstrate desirable biocompatibility and pro-regenerative effects. The mechanism of integrated O2 and H2 gas therapy has been identified as a TNFAIP3/hnRNPA1 ubiquitination/ferroptosis signaling axis, establishing for the first time a direct link to ferroptosis. In conclusion, this study yields a transformative concept and a ferroptosis-targeting microneedle material with well-defined molecular mechanism for diabetic wound management.

Damage to the pelvic nerve can occur at the time of a radical hysterectomy or during resection of a rectal cancer or sacrococcygeal teratoma and lead to a neurogenic bladder and an inability to volitionally void. We report on our experience with somatic-to-autonomic nerve regeneration by obturator-to-pelvic nerve rerouting and its results in terms of restoration of normal bladder function. Eleven patients (2 male, 9 female; age range 4–58 years) with a neurogenic bladder following radical hysterectomy or resection of a sacrococcygeal teratoma underwent an obturator-to-pelvic nerve rerouting procedure. Urodynamic studies to evaluate bladder function and renal function studies were obtained preoperatively and up to 18 months post nerve rerouting and compared. All patients could not void volitionally when enrolled. Nine of the 11 patients had restored voluntary voiding postoperatively. For the nine patients, pre and postoperative studies demonstrated remarkable improvement in bladder function with an increase in voiding volume from 0 to 285 ± 5.8 ml (P < 0.001), a decrease in residual urine volume from 240 ± 141.4 ml to 23 ± 18.6 ml (P < 0.01), an increase in detrusor contraction pressure (Pdet) from 3 ± 3.3 to 39 ± 6.5cmH2O cmH2O (P < 0.001), return of urge sensation, a decrease in recurrent urinary tract infections from an average of 10 times/year preoperatively to almost none in patients who achieved voluntary voiding within 6 months postoperatively, and normalization in 3 of the 4 patients with elevated serum creatinine. The procedure was technically straightforward and safe with no complications reported. One patient showed no improvement, and one patient did not return for follow-up due to recurrence and metastasis of her cervical cancer. Somatic-to-autonomic nerve regeneration by obturator-to-pelvic nerve rerouting can restore bladder sensory and motor function as well as voluntary voiding for patients with neurogenic bladder after sacrococcygeal teratoma resection or radical hysterectomy. (Chinese Clinical Trial Registry number: ChiCTR2100043618).

Introduction: Ureteral stricture is a rare complication following hematopoietic stem cell transplantation (HSCT). However, its management poses challenges due to the patient’s long-term immunosuppression and the limited clinical experience of doctors. This represents the first report of a patient who underwent lingual mucosa graft ureteroplasty (LMGU) for the management of long-segment ureteral stricture following HSCT. Surgical techniques and perioperative management strategies are described. Case Presentation: A 25-year-old female with a 10-cm-long proximal and middle ureteral stricture following HSCT was successfully treated with robotic-assisted LMGU. The procedure lasted 270 min without conversion and intraoperative complications. Intraoperative blood loss was estimated at 50 mL. Postoperative complications included lymphatic fistula (Clavien-Dindo grade I) and left upper extremity venous thrombosis (Clavien-Dindo grade II). The double-J stent was removed 8 weeks postoperatively. Antegrade urography performed at 10 weeks showed an unobstructed urinary tract. During follow-up assessments, the patient reported no symptoms after surgery. The glomerular filtration rate of the left kidney increased from 27.45 mL/min preoperatively to 38.79 mL/min postoperatively. Renal ultrasound performed at 3, 6, 9, and 12 months demonstrated improved hydronephrosis compared to preoperative imaging. Conclusion: Based on the satisfactory outcomes in this case, robotic-assisted LMGU appears to be a safe, minimally invasive, and effective reconstructive technique, providing a promising treatment for select patients with post-HSCT long proximal ureteral strictures.

To evaluate the feasibility and safety of using colorectal mucosal grafts (CMG) harvested via endoscopic submucosal dissection (ESD) for ureteral reconstruction in patients with ureteral stricture. Eight patients with ureteral stricture underwent robotic ureteral reconstruction using CMG harvested by ESD. Preoperative assessments included clinical history, physical examination, and various imaging studies. The ESD procedure was performed with standard precautions to obtain sufficient graft material. Postoperative follow-up involved endoscopic examinations and retrograde pyelograms to assess colorectal complication and ureteral patency. The average age of patients was 44 years, and the median BMI was 24.6 kg/m². The causes of stricture included ureteral stones, urinary tract infections, and ureteral polyps. The median stricture length was 3.5 cm. The average size of the harvested CMG was 4 × 2.4 cm. The success rate of the grafting procedure was 100%, with no gastrointestinal complications observed. Endoscopic examination one week postoperatively revealed well-healed wounds. No recurrent ureteral strictures were noted during a median follow-up period of 5 months. The average glomerular filtration rate (GFR) of the affected kidneys was 61 ml/min. Harvesting CMG via ESD for ureteral reconstruction is feasible and safe, with minimal complications and promising short-term outcomes. This technique provides a viable alternative for patients contraindicated for oral mucosal grafts, potentially reducing morbidity associated with traditional intestinal mucosa harvesting methods.

Background:Complex proximal and mid-ureteral strictures, caused by calculi, inflammation, fibrosis, or iatrogenic injury, can result in hydronephrosis and renal function loss. Traditional ureterography, when used alone, has limitations in accurately assessing stricture length and detecting multiple segments. We evaluated the diagnostic value of the combined antegrade and retrograde ureterography (CARU) technique in complex strictures, focusing on stricture length, location, and severity. Methods:This retrospective study collected data from 110 patients diagnosed with proximal and mid-ureteral strictures at our center between January 2023 and November 2025. All patients were evaluated with CARU 4 weeks prior to surgery and subsequently underwent lingual mucosal graft (LMG) ureteroplasty. A comparative analysis was performed to assess the correlation between the preoperative CARU assessment of stricture data and the intraoperative findings. Subgroup analyses were conducted according to stricture etiology and severity. Results:CARU demonstrated excellent agreement with intraoperative findings for stricture location (κ=0.93, P<0.001) and substantial agreement for stricture severity (κ=0.69, P<0.001). CARU tended to underestimate the true length of ureteral strictures and, consequently, the graft length required for reconstruction. The stricture length measured by CARU (2.89±2.29 cm) was, on average, 0.74 cm shorter than the intraoperative stricture length (3.63±1.88 cm; P<0.001) and 0.93 cm shorter than the intraoperative LMG length (3.82±1.80 cm; P<0.001). In subgroup analyses, CARU-measured stricture length was broadly comparable with both intraoperative stricture length and graft length in congenital or idiopathic cases, but underestimated these lengths in patients with acquired etiologies and severe strictures. Nevertheless, ICC analysis demonstrated good agreement between CARU-based and intraoperative measurements. Conclusions:CARU is a valuable tool for evaluating complex proximal and mid-ureteral strictures, with high accuracy in assessing stricture location and severity. It provides valuable reference for estimating stricture and graft lengths. It could serve as a useful preoperative imaging modality for patients with proximal and mid-ureteral strictures.

Background:Vesicourethral anastomotic stenosis (VUAS) is a challenging complication, occurring in 2%-7% of patients following radical prostatectomy. Endoscopic treatment fails in some patients, severely impairing their quality of life. Open reconstructive surgery is technically demanding with a long learning curve. Thus, to address a complication known as vesicourethral anastomotic stenosis following radical prostatectomy, we propose a new robot-assisted vesical neck H-shaped plasty. Case Description:A 57-year-old patient with prostate cancer developed vesicourethral anastomotic stenosis (with a stenosis segment length of 2 cm) 4 months after laparoscopic radical prostatectomy. Following short-term recurrence of the condition after three transurethral incisions for VUAS, the patient received robot-assisted vesical neck H-shaped plasty for posterior urethral reconstruction. The surgical technique primarily involves constructing an H-shaped bladder flap, tubularizing it to reconstruct a funnel-shaped posterior urethra, performing a tension-free anastomosis between the vesical neck and the posterior urethra, and constructing a retrocurvature structure of the urethra. Treatment success was defined by both anatomical and functional criteria, unobstructed passage of a 17 Fr cystoscope or a urinary flow rate >15 mL/s. The patient in this study achieved adequate early urinary patency and no related complications. Conclusions:Based on short-term follow-up, robot-assisted vesical neck H-shaped flap plasty is feasible for vesicourethral anastomotic stenosis, but long-term follow-up is needed for verification.

BACKGROUND:The management of long proximal ureteral strictures poses a significant challenge, with traditional options such as renal autotransplantation or bowel interposition associated with substantial morbidity. This study explores the use of robotic ureteroplasty with lingual mucosal graft (RU-LMG) as a minimally invasive approach for treating complex ureteral strictures. We present a multi-institutional cohort to evaluate its effectiveness in managing proximal and mid-ureteral strictures. METHODS:This multi-center, retrospective study analyzed perioperative data from 76 patients who underwent RU-LMG at three institutions between January 2021 and December 2023. Patients were selected based on the presence of proximal or mid-ureteral strictures not amenable to primary ureteroureterostomy due to periureteral fibrosis or excessive stricture length. Success was defined as the absence of hydronephrosis, flank pain, or imaging-confirmed obstruction. RESULTS:Of the 76 patients, 48 (63.2%) underwent onlay ureteroplasty, while 28 (36.8%) received augmented anastomotic RU-LMG. Omental wrapping or coverage of the reconstructed ureter was performed in 73 patients (96.1%). The average length of the stricture and graft were 4.0 cm (range: 2.0-11.5 cm) and 4.1 cm (range: 2.0-12.0 cm), respectively. The mean operative time was 205.5 minutes (range: 95-380 minutes), with a mean blood loss of 70.9 mL (range: 10-400 mL). There were no open conversions or intraoperative complications. The follow-up period ranged from 13 to 48 months (mean: 27 months), with a 100% success rate (76/76 patients). CONCLUSIONS:RU-LMG is a safe, effective, and feasible technique for managing complex proximal or mid-ureteral strictures, with excellent medium-term outcomes and minimal morbidity.

Background:Ureteral avulsion is a rare but serious complication of ureteroscopic lithotomy. As a common treatment for long segment ureteral avulsion, ileal ureteral replacement has many complications, such as anastomotic site stricture and retrograde infection, and prolonged exposure of the intestinal mucosa to urine may result in postoperative metabolic acidosis. Autologous tissue is becoming increasingly popular in ureteroplasty, including oral mucosa, appendix and bladder. Recent advancements in ureteral reconstruction techniques have highlighted the utility of the appendix and bladder, but the length of autologous tissue is limited. In order to reduce complications and save autologous tissue, we propose a novel combined technique. This study aims to evaluate the feasibility and outcomes of appendiceal onlay flap ureteroplasty combined with Boari flap-psoas hitch ureteroneocystostomy in the treatment of long segment ureteral avulsion, with a 15-month follow-up. Case Description:We report a 64-year-old male patient diagnosed with right ureteral avulsion. In this case, the ureteral reconstruction was accomplished through our new technique. Antegrade urography revealed no obstruction of the reconstructed ureteral segment at 7 weeks after surgery. After a 15-month follow-up period, no postoperative complications occurred, radiological resolution of hydronephrosis and improved renal function were observed. Conclusions:Our initial experience demonstrated that appendiceal onlay flap ureteroplasty combined with Boari flap-psoas hitch ureteroneocystostomy is safe and feasible. This novel surgical method provides a promising option for treating long segment ureteral avulsion.

To investigate the effect of ureteral rest on outcomes of ureteral reconstruction (UR) and analyse the risk factors for postoperative recurrence of ureteral stricture. A retrospective study was conducted on patients with ureteral strictures who underwent ureteral rest or did not undergo ureteral rest prior to UR using propensity score matching (PSM). Furthermore, univariate, and multivariate regression models were used to analyse the risk factors for the recurrence of ureteral stricture. A total of 261 patients were grouped according to whether they underwent ureteral rest. After PSM, two groups of 82 patients were selected for the comparative study. The ureteral rest group had a higher surgical success rate (96.34

This study aims to evaluate the effectiveness of upper pole calyx fornix subapical puncture in percutaneous nephrolithotomy (PCNL) compared to traditional middle calyx puncture. The subapical puncture technique offers the advantages of upper pole access while minimizing the risk of pleural injury. We conducted a retrospective analysis of 194 patients who underwent PCNL at our hospital from May 2022 to November 2023. Patients were divided into two groups based on puncture technique: the Upper-PCNL group (n = 122) with upper pole calyx fornix subapical puncture and the Mid-PCNL group (n = 72) with middle calyx fornix apex puncture. Data collected included tract establishment time, operative time, stone-free rates, complications, and auxiliary procedures. The Upper-PCNL group demonstrated significantly higher primary stone-free rates (83.6

Background:Recurrent ureteropelvic junction obstruction (UPJO) accompanied by long proximal ureteral obliteration presents significant challenges for conventional pyeloplasty, primarily due to the elevated tension at the surgical site. Additionally, previous surgeries often lead to scar tissue formation, complicating both the identification of healthy tissue and the success of reconstruction. Case Description:A 38-year-old patient with right UPJO successfully underwent robotic tubular pyeloureteroplasty using a flap and lingual mucosal graft (LMG). The surgical technique involved using the flap to form the posterior plate of the anastomosis, with the LMG serving as the anterior plate, resulting in a wide, tubularized, and well-vascularized ureteropelvic junction. Intraoperative blood loss was about 50 mL, and operative time was about 220 minutes. Follow-up ultrasound demonstrated sustained reduction in hydronephrosis, which was further confirmed by improved findings on computed tomography urography. Antegrade urography confirmed the absence of ureteral obstruction following removal of the Double-J stent, with no complications observed. During follow-up assessments, the patient reported no symptoms after surgery. By sixteen months postoperatively, the glomerular filtration rate of the right renal increased from 25.03 to 28.03 mL/min, and split renal function improved from 33.00% to 37.56%. Conclusions:Robotic tubular pyeloureteroplasty using a flap and LMG is a safe and effective surgical option, offering a promising treatment for selected patients with UPJO. This technique serves as an alternative for those with complex anatomical challenges typically encountered in pyeloplasty.

PURPOSE:To evaluate the effectiveness and safety of an upgraded integrated vacuum suction catheter in semi-rigid ureteroscopic laser lithotripsy (VC-URSL) compared to traditional methods for treating impacted upper ureteral stones. PATIENTS AND METHODS:This prospective, randomized controlled trial was conducted from September 2022 to March 2024 at a single center, enrolling 95 patients aged 18-70 years with a single radiopaque impacted upper ureteral stone. Participants were randomized into two groups: the VC-URSL group used an integrated vacuum suction catheter featuring a stainless steel stabilizing tube and a narrowed distal end to prevent obstruction, while the T-URSL group underwent standard ureteroscopic lithotripsy without vacuum assistance. Both groups utilized a holmium-YAG laser under general anesthesia. Primary outcomes included operative time, stone-free rates on the first postoperative day and after one month, and complication rates, specifically fever and stone retropulsion. RESULTS:The VC-URSL group achieved significantly shorter operative times (37.60 ± 3.87 min vs. 46.21 ± 7.54 min, P < 0.001) and higher initial stone-free rates (91.7% vs. 74.5%, P = 0.025) compared to T-URSL. Additionally, the VC-URSL group had fewer complications, with lower rates of fever (2.1% vs. 17.0%, P = 0.015) and stone retropulsion (6.3% vs. 21.3%, P = 0.033). CONCLUSIONS:VC-URSL offers a more effective, safer, and efficient alternative to T-URSL, enhancing outcomes while reducing complications. Further multicenter trials with larger populations are recommended for broader validation.

Background:Omentum has a wide application value in ureteroplasty, however, some specific situations limit its clinical application. Therefore, we modified the application method of omentum and proposed a new method named omental covering (OC) technique. This study aims to systematically evaluate the safety and efficacy of OC technique in robot-assisted lingual mucosa graft ureteroplasty (RA-LMGU). Methods:We conducted a retrospective analysis of data from 79 patients who underwent RA-LMGU between June 2021 and October 2024 at two hospitals. Patients were divided into two groups according to the method of omental application: the omental wrapping (OW) group and the OC group. Perioperative and follow-up data were collected. Results:A total of 79 patients were included, with 24 in the OW group and 55 in the OC group. The median ureteral stricture length was 4.3 [interquartile range (IQR), 3.7, 6.0] cm in the OW group and 3.0 (IQR, 2.1, 4.0) cm in the OC group (P<0.001). The median operative time was 181 (IQR, 139, 217) min in the OW group and 150 (IQR, 110, 198) min in the OC group (P=0.06). The median postoperative stay was 7 (IQR, 7, 8) days in the OW group and 6 (IQR, 5, 7) days in the OC group (P<0.001). The median follow-up time was 32 (IQR, 26, 39) months in the OW group and 11 (IQR, 4, 16) months in the OC group (P<0.001). It is worth noting that both groups achieved a 100% surgical success rate. Conclusions:These short-term follow-up results demonstrated that the OC technique is also safe and effective in ureteral repair and reconstruction using lingual mucosa graft and it can reduce postoperative stay.

Background: Urethral injury is the primary cause of urinary tract stenosis and hydronephrosis. Limited by the common drawbacks of autografts, the clinical treatment of urethral injury remains challenging. In recent years, biocompatible and biodegradable biomaterials (BBBs) are emerging as a potential substitute for autografts to upgrade the research paradigms of regenerative medicine. However, ideal BBBs for urethral regeneration have rarely been reported. Methods: A Janus nanofibrous PC/SMC patch composed of the outer layer of PLLA/CRRI-3 nanofibers and the inner layer of SF/MCe heterojunction nanofibers were first fabricated. Its antibacterial and antioxidant properties were assessed. After passing biosafety evaluation, the patch's efficacy in repairing urethral defects was evaluated using a rabbit model, with repair outcomes analyzed via histological staining. Results: PC/SMC patch not only inhibits bacterial proliferation and survival via the release of the antibacterial peptide CRRI-3, but it also relieves oxidation stress and promotes tissue regeneration by the nanozyme-like activities of the MCe heterojunction. The biocompatibility of PC/SMC patch has met the general requirements for Class-III medical devices. The application in vivo was evaluated using a urethral injury model of rabbits. The results showed that PC/SMC patch could improve urethral regeneration and prevent urethral stricture via multiple mechanisms, including promoting re-epithelialization, cell proliferation and M2 macrophage polarization, and inhibiting of fibrosis and scar formation. Conclusion: The PC/SMC nanofibrous patch has good biocompatibility and antibacterial properties, and can effectively promote the regeneration and repair of urethral tissue.

Objective: To describe and evaluate the technique using bilateral Boari flap ureteroneocystostomy (BBFUNC) for bilateral mid-lower ureteral strictures. Methods: We retrospectively reviewed five patients who underwent minimally invasive BBFUNC in our institution (Union Hospital, Wuhan, China) between July 2019 and December 2021. The bilateral ureters were mobilized and transected above the stenotic segments. The bladder was isolated and incised longitudinally from the middle of the anterior wall. Then, an inverted U-shaped bladder flap was created on both sides, fixed onto the psoas tendon, and anastomosed to the ipsilateral distal normal ureter. Following double-J stenting, the Boari flaps were tubularized, and the bladder was closed with continuous sutures. The patients' perioperative data and follow-up outcomes were collected, and a descriptive statistical analysis was performed. Results: No case converted to open surgery, and no intraoperative complication occurred. The median surgical time was 230 (range 203-294) min. The median length of the bladder flaps was 6.2 (range 4.3-10.0) cm on the left and 5.5 (range 4.7-10.5) cm on the right side. All patients had not developed recurrent ureteral stenosis during the median follow-up time of 17 (range 16-45) months and had a normal maximum flow rate after surgery. The median post-void residual was 7 (range 0-19) mL. The maximal bladder capacity was decreased in one (20%) patient. Conclusion: The present study demonstrates that minimally invasive BBFUNC is feasible and safe in treating bilateral mid-lower ureteral strictures, and the impact on lower urinary tract function is limited. 2024 Editorial Office of Asian Journal of Urology. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/).

Background: Bladder outlet obstruction (BOO) represents a common cause of lower urinary tract symptoms in men, frequently resulting from benign prostatic hyperplasia. Key symptoms include both obstructive and irritative urinary tract symptoms, such as dysuria, increased frequency and urgency of urination, and recurrent urinary tract infections. BOO can also cause upper urinary tract dilation (hydronephrosis), damage structure, and impair function of the bladder. Objective: Early diagnosis of BOO is essential to the protection of kidney and bladder functions. The gold standard for diagnosing BOO is urodynamic studies (UDS), which measure detrusor pressure and urinary flow. However, UDS is an invasive test and is associated with risks for urinary tract infections, bothersome urinary symptoms, and hematuria. Given the invasiveness and discomfort associated with UDS, non-invasive diagnostic methods have been developed. Nevertheless, the main limitation of these techniques is the variability in threshold values, highlighting the need for further standardization of measurement protocols. This article reviews the current diagnostic approaches for BOO in men and explores their clinical utility. Conclusion: Various non-invasive diagnostic methods are promising; yet, UDS remains the primary diagnostic approach.

Objective:To investigate the feasibility of using a colonic mucosa graft (CMG) for ureteral reconstruction and assess histological changes following the engrafted CMG in Beagles. Methods:Nine male Beagle dogs were randomly assigned to groups I, II, and III (n=3). Resection of half of the ureteral wall caused a ventral ureteral defect. Ureteral defects with lengths of 3 cm, 5 cm, and 10 cm were created in these groups, respectively. The CMG was harvested and used to repair the ureteral defects in an onlay fashion. After functional evaluation of the reconstructed ureter using CT urography at 3 months, 6 months, and 12 months postoperatively, one Beagle from each group was euthanized using air embolization. Ureteral diameter measurements and the CMG shrinkage rate calculations were performed. Histological analysis was conducted to assess changes in the engrafted CMG. Results:All animals had no postoperative complications. CT urography showed normal renal function and a wide caliber ureter with no stricture or leakage. The ureteral diameter reconstructed by the CMG was larger than that of the proximal or distal normal ureter (p<0.05). The mean shrinkage rate of the CMG ranged from 11% to 14%. From 3 months to 12 months postoperatively, the colonic mucosal epithelium gradually underwent metaplasia into urothelium, and smooth muscle and neovascularization gradually developed beneath the mucosa. Conclusion:The novel technique of using a CMG for ureteral reconstruction is feasible. The CMG has the advantages of low shrinkage rate and minimal donor site complications. It is an ideal material for treating long ureteral strictures.

PURPOSE:To explore the role of the Whitaker test in evaluating the postoperative outcome of upper urinary tract reconstruction surgery in patients carrying a nephrostomy tube after surgery.PATIENTS AND METHODS:This was a prospective observational study performed in 42 patients with nephrostomy tube undergoing the Whitaker test after upper urinary tract reconstruction surgery between January 2020 and December 2021. Data on clinical information, the Whitaker test and surgical procedure were collected prospectively, and the long-term follow-up results were analysed retrospectively.RESULTS:The 46 ureters of 42 patients (right 16, left 22, bilateral 4) underwent six common upper urinary tract surgical reconstruction procedures and one combined procedure, including pyeloplasty, ureteroureterostomy, lingual mucosal onlay graft, appendiceal onlay flap, ureteral reimplantation, Boari flap, and ipsilateral lingual mucosal onlay graft combined ureteral reimplantation. All patients underwent the Whitaker test successfully without any discomfort after examination. The postoperative Whitaker test showed 43 kidneys without obstruction and 3 kidneys with obstruction. At a median follow-up of 18 months (range 13-31), the follow-up results showed that the overall success rate of the surgery was 100% (46/46). Concerning the concordance Whitaker test and follow-up results, the observed proportion of agreement was 93.5% (43/46).CONCLUSION:The Whitaker test can achieve similar consistency with the long-term follow-up results after upper urinary tract reconstruction surgery and can be used as a tool to evaluate the surgical efficacy of upper urinary tract reconstruction surgery, which can provide a prognostic efficacy evaluation for patients carrying a nephrostomy tube after surgery.