Evaluation of tissue oximetry in per

Percutaneous endoprostheses were recently introduced as an adjunctive therapy for arterial occlusive disease. Clinical experience in 137 patients showed encouraging technical success in the follow-up results in patients with iliac lesions. A low patency rate in femoral arteries, however, restricts stent implantation to selected cases. So far, indications for lesions located elsewhere have not yet been fully accepted. Because long-term follow-up data are not yet available, stent placement should be applied to a subset of lesions that are not amenable to balloon angioplasty alone.

Urethral strictures recur in about 30% of the cases irrespective of treatment. We describe a new urethral stent, originally developed in our institution for vascular use after transluminal angioplasty. We have previously tested the biocompatibility and tolerance in the normal urethra of dogs in a study with a 1-year follow-up undertaken in 1986. The stent has a braided structure, made of fine stainless steel wires and is self-expanding when released from a special endoscopic instrument. Since November 1987, we have implanted the stent in 25 men (mean age 54 years), after a previous urethrotomy had been performed. Eighteen were evaluated. Results are good, morbidity and complications occasional. This new technique has a considerable future in treating recurrent urethral stricture.

Urethral strictures recur in about 30% of the cases whatever might be the treatment. We describe a new urethral stent, originally developed in our Institution for vascular use after transluminal angioplasty. Since january 1986, we previously have controlled the biocompatibility and tolerance into the normal urethra of dogs with a one year of follow-up. The stent has a braided structure, made of fine stainless steel wires and is self-expanding when released from a special endoscopic instrument. From november 1987, we have implanted the stent into 11 males (mean age 54 years), after a previous urethrotomy has been performed. In two patients a second stent has been implanted for incomplete result. Now with a mean follow-up of 12 months all patients recovered normal micturation, only two complained of slight stress incontinence.

A new type of biliary stent was inserted in 45 patients with symptomatic biliary strictures, 40 malignant and five benign. The stent is made of stainless steel woven into a tubular mesh. It is introduced in compressed form on a 7- or 9-F delivery catheter and released at the site of the stricture. Fully open, the stent has an internal diameter of 1 cm. The 30-day mortality was 7%. The early (less than 72 hours) complication rate was 16%. Recurrent jaundice occurred in 42%; late complications of sepsis without jaundice occurred in an additional 11%. None of the stents migrated. This new design allows a large-diameter stent to be inserted percutaneously without increased risk of complications. The frequency of recurrent jaundice, however, was not less than that observed with plastic stents, but this may have reflected the spectrum of patients treated, many with hilar strictures and previous interventions.

Many patients are condemned to repeated urethral dilatations because of the poor efficacy of treatment for male urethral stricture. The authors have recently used a new urethral prosthesis: a metal-reinforced, meshed tube which opens in the urethra and maintains a it open allowing the urothelium to grow over. The prosthesis therefore becomes incorporated in the wall of the urethra. they have implanted this prosthesis in 21 patients with a mean age of 61 years, essentially in the bulbar urethra, for longstanding strictures measuring 5 to 35 mm and unresponsive to currently available treatments. The endoscopic insertion of the prosthesis is performed after dilatation. The mean follow-up is 9 months. The stricture was correctly treated in all patients (three patients required two sessions). The follow-up of these patients is short and the stability of these favourable results needs to be confirmed by a longer follow-up.

Nine patients with complete quadriplegia underwent external striated sphincter stenting with the Wallstent in place of an external striated sphincterotomy. Although suprapubic catheters were placed to provide an outlet should problems develop with the stent, they were successfully removed within 6 weeks in all but 1 patient. Complete bladder emptying with reduced voiding pressures was achieved, together with a significant reduction in the duration of hyper-reflexic contractions. Epithelialisation of the stent was almost complete within 3 months and intermittent catheterisation or endoscopy (and resection) is possible through the stent. Although this is a preliminary report of this new technique, it is hoped that sphincter stenting will provide a rapid, safe and effective method of treating high pressure hyper-reflexia and detrusor sphincter dyssynergia in quadriplegic patients.

Under local anaesthesia, 19 patients (18 with acute and 1 with chronic urinary retention) underwent insertion of an expandable stainless steel tubular "stent" into their prostatic urethra under fluoroscopic control. All were considered to be at major risk from prostatic surgery. The 18 patients with acute retention voided spontaneously following the initial stent procedure, but the patient with chronic retention required a period of suprapubic catheterisation. Following the endoscopic insertion of an additional stent this patient also voided spontaneously. During a follow-up period of 3 to 7 months (mean 4), 4 patients were lost to follow-up. The remaining 15 patients all void spontaneously. Recurrent asymptomatic urinary tract infections were seen in all but 1 patient initially, but none of those who were followed up for over 5 months had evidence of infection. Although the follow-up period is limited, the results to date demonstrate that the insertion of an expandable prostatic stent is a safe and reliable method of treating acute urinary retention in patients unfit for surgery. Further follow-up is required to assess long-term safety and to exclude late complications.

Twenty-one patients with prostatic urethral obstruction who were unfit for surgery were treated with self-expandable stainless steel endoprostheses inserted under fluoroscopic guidance. The procedure was technically successful in all patients, although in one case a second stent was required 2 months later. One patient developed a urethral stricture in the 12-16 month follow up period. One case of epididymoorchitis and one case of septicaemia after stenting were treated successfully with antibiotics. Endoprostheses represent a satisfactory alternative to prostatectomy in high-risk patients.

Urethral strictures recur in about 30% of the cases whatever the treatment. We describe a new urethral stent, originally developed in our Institution for vascular use after transluminal angioplasty. Since January 1986, we have controlled the biocompatibility and tolerance in the normal urethra of dogs with a one year follow-up. The stent has a braided structure, made of fine stainless steel wires and is self-expanding when released from a special endoscopic instrument. From November 1987, we have implanted the stent into 11 males (mean age 54 years), after previous urethrotomy. In two patients a second stent was implanted for incomplete result. Now, with a mean follow-up of 12 months, all patients have recovered normal micturition and only two complain slight stress incontinence.

Forty-five patients with atherosclerotic stenoses and occlusions of the iliac and superficial femoral arteries were treated with a flexible, self-expanding, metallic intravascular stent. Of these patients, 37 were treated immediately after inadequate angioplasty. At a follow-up period of 2-12 months, intravenous digital subtraction angiograms demonstrated patency of the vessels with stents in 40 of 45 patients. The mean Doppler ankle/arm index increased from 0.60 to 0.92 immediately after treatment and was 0.89 at follow-up. Early thrombotic stent occlusion occurred in two patients. Intimal hyperplasia was a late effect and led to stent stenoses in three patients after 5-9 months and stent occlusion in one patient after 6 months. In three patients, percutaneous recanalization with balloon and Simpson catheters was successful. Intravascular stents proved particularly useful for maintenance of patency after angioplasty in occlusions of the iliac and femoral arteries and in treatment of stenoses due to eccentric and severely ulcerated plaques. The stents also helped manage complications after angioplasty. Long-term results will depend on the degree, frequency, and progression of intimal hyperplasia narrowing the vascular lumen.

Urethral strictures recur in about 30% of the cases irrespective of treatment. We describe a new urethral stent, originally developed in our institution for vascular use after transluminal angioplasty. We have previously controlled the biocompatibility and tolerance in the normal urethra of dogs in a study with a one year follow-up that was undertaken in 1986. The stent has a braided structure, made of fine stainless steel wires and is self-expanding when released from a special endoscopic instrument. Since November 1987, we have implanted the stent in 11 men (mean age 54 years), after a previous urethrotomy had been performed. In two patients a second stent was implanted for incomplete result. Now with a mean follow-up of 12 months all patients are continent, and only two patients have complained of slight stress incontinence.

A flexible, self-expanding metallic endoprosthesis was employed for the treatment of venous outflow stenoses in four patients with a polytetrafluoroethylene shunt and two patients with a Brescia-Cimino shunt. The stenoses had led to shunt occlusion in five patients and to flow impairment in one. In the occluded shunts, thrombectomy and subsequent balloon angioplasty were performed in four patients, and percutaneous recanalization with angioplasty was performed in one. One shunt with decreasing flow was percutaneously dilated. Since the underlying stenoses recurred in four patients after 24 hours and did not respond sufficiently to angioplasty in two patients, up to four stents were placed in the venous segments. Thrombosis of the stents occurred in two patients after 24 hours and in one after 6 weeks and was successfully recanalized with thrombectomy in two. At 2-6 months follow-up, the stents and the shunts were patent in five patients. In three of these patients, intima hyperplasia, associated with narrowing of the stent lumen in two, was noted within 4 months after stent placement.

We describe a new urethral stent, originally developed for endovascular use, that we have implanted into 8 patients with urethral strictures. The stent is woven in the form of a tubular mesh from surgical grade stainless steel wire and is self-expanding when released from its small diameter delivery catheter. All patients have been treated successfully with a good caliber urethra visible on urethrography and direct endoscopy, and with improved urine flow rates. Mean followup of these patients is 8 months (range 6 months to 1 year). Urethroscopy has demonstrated complete epithelial covering of the implant at 4 to 6 months. Although the followup is short it seems that this simple technique may offer a lasting treatment for many urethral strictures.

We describe a new urethral stent which was implanted into 12 patients with urethral strictures. The stent is woven in the form of a tubular mesh from fine stainless steel wire and is self-expanding when released from its small diameter delivery catheter. All patients have been treated successfully, with a good calibre urethra visible on urethrography and direct endoscopy and with improved urine flow rates. The mean follow-up of these patients was 7 months (range 2-13). Urethroscopy demonstrated complete epithelial covering of the implant in 4 to 6 months. Although the follow-up period was short, it seems that this simple technique may offer a lasting treatment for many urethral strictures. A longer follow-up will be necessary to exclude late complications.