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Introduction Urinary fistula is a rare complication following robot‐assisted partial nephrectomy. For cases refractory to conservative treatment, only ureteral stent placement and percutaneous drainage are the established treatment alternatives. Case presentation A 44‐year‐old man presented with urinary fistula 3 weeks after robot‐assisted partial nephrectomy for right renal cell carcinoma. Follow‐up observations were conducted for 2 weeks; however, no improvements were observed. Additionally, the patient did not improve following percutaneous drainage and ureteral stent insertion. Subsequently, the patient received percutaneous injections of fibrin glue, with the urinary fistula showing significant improvements on the following day. Conclusion Our findings indicated that percutaneous fibrin glue injection can effectively treat refractory urinary fistula following partial nephrectomy.

Existence of vesicovaginal fistula is known since ancient days and has been considered related to tedious labour. It continues to be a health care issue in those communities where obstetrician and midwifery care are scarce. Initial descriptions of surgical treatment started within the XV century, but the first detailed description of a curative technique was made in 1852. Urethral and perineal fistula are also known since ancient days related to the treatment of urethral stricture or bladder stones in males. The implementation of anaesthesia and antisepsis have been a great aid to the advancement of surgery and relief to urinary fistula patients all over the world.

Introduction: Fistulas between urethra and hip joint are rare. Only six cases of urethra-acetabular fistula have so far been reported in literature. Case reported herein may be just the seventh ever reported case of Fistula between urethra and hip joint. Case report: Urethral Fistula was positively diagnosed by a cysto-urethrographic study. Communication of Urethral fistula with splinter of bomb blast, lodged on quadrilateral plate on medial wall of acetabulum was also established in cysto-urethrographic study itsel. Hip involvement was insidious in onset without symptoms of overt septic hip, neither at time of injury nor in follow up period except for recurring relapsing discharging sinus. Leakage of dye of sinogram around femoral head established track from splinter to hip joint. Decreased hip joint space, well recognisable even in cysto-urethrographic study progressed to bony ankylosis slowly over 7 years. Discussion: Scientific rationale of absence of overt clinical symptoms of septic arthritis, its insidious onset, slow progression is discussed. Rationale of development of Discharging sinus posterior on buttock despite wound of entry of splinter being in perineum is discussed. Conclusion: Presented here is first ever case of urethroacetabular fistula resulting from splinter of a bomb blast and only second from a penetrating injury, second with no associated fractures in pubic rami or acetabulum. This is also first ever report of long-term outcome of septic arthritis of a urethro-acetabular fistula. The learning point is that a urethra-acetabular fistula may follow a benign course and painless bony ankylosis occurs as the final sequelae if no intervention is done.

Objective: Hypospadias is a common congenital problem among male newborns. Both rapid absorbable sutures (polyglactin, Vicryl) and delayed absorbable sutures (polydioxanone, PDO) are used in hypospadias repair based on the surgeon's preference. This study was conducted to compare post-urethroplasty complication rates in pediatric patients with hypospadias using Vicryl or PDO sutures. Methods: This is a retrospective study which was designed and performed on 583 children aged 1–7 years old who had undergone hypospadias repair from January 2012 to December 2018. Required data were obtained from the patients' medical records. Results: Overall, post-surgical complications were observed in 60 (10.3%) patients comprising urethro-cutaneous fistula (n=39, 6.7%), meatal stenosis (n=10, 1.7%), urethral stricture (n=7, 1.2%), and glans dehiscence (n=4, 0.7%). The mean age of the children with complications was 3.0±1.3 years. According to Kaplan-Meier estimate, the interval between surgery and development of complications was significantly shorter in the Vicryl group (p=0.037). Overall, complications were more prevalent in Vicryl suture than PDO suture (15.1% vs. 5.3%, p

Objectives: Arterio-ureteralfistula (AUF) is an infrequent but potentially life-threatening condition. The aim of this study was reviewing the literature to build a flow-chart useful for an early and effective diagnosis and treatment of this pathology. Materials and methods: A literature search in PubMed was con-ducted. In addition, retrieved articles were cross-referenced. Data parameters included oncologic, vascular and urological history, diagnostics, treatment, and follow up were collected using a standard template by 2 independent reviewers. Results: A total of 140 cases of AUF out of 172 available in the literature at the time of the review, were considered. All patients presented gross hematuria. Chronic indwelling ureteral catheter (CIUC); history of pelvic surgery (HPS) and history of pelvic radiotherapy (HRT) were present respectively in 81%, 62.1%and 58.6% of the sample. The most predominant location of AUF was at the common iliac artery ureteral crossing. Angiography with provocative measures had the highest diag-nostic sensitivity (50%) and endovascular treatment with stent-graft placement across the fistula is the current state of the art treatment choice. Conclusions: Failure to diagnose can postpone a potentially life-saving targeted therapy and lead to complications. The identifi-cation of the Trifecta hematuria, history of pelvic surgery (HPS) and history of pelvic radiotherapy (HPR) would allow the identi-fication of patients at high risk of AUF, who may benefit from more sensitive early diagnostic investigations such as CT angiography and provocative angiography. The treatment of choice in case of AUF to date consist in endovascular prosthesis placement.

Hydatid cyst is a major health problem in developing countries. The kidney is in third position of organs affected by hydatid cyst. One of the complications of renal hydatid cyst is a urinary fistula. The purpose of this study is to identify preoperative predictive factors of urinary fistula in renal hydatid cyst and to develop a scoring system for this disorder. We retrospectively analyzed all patients operated for renal hydatid cysts between January 2000 and December 2020. We divided our patients into two groups according to whether or not the renal hydatid cysts opened in the urinary tract. Predictive factors of the presence of a urinary fistula have been studied to obtain a simple score to predict the presence of a urinary fistula. Differences were considered significant if p 500/mm3, (p = 0.01), cyst diameter >5 cm (p = 0.02), and upper or lower renal pole location (p = 0.003) were significant and independent predictors of urinary fistula. A score was developed to predict the opening of the cyst in the urinary tract. The total score varies between 0 and 15. The resulting area under the receiver operator characteristic curve was 0.798 (95% CI, 0.726–0.866; p = 0.023). At a cutoff point ≥8, the specificity achieved was 100%. Preoperative detection and management of urinary fistula are important issues in the treatment of renal hydatid cyst. Developing a scoring system based on routinely measured laboratory and radiologic factors will help the clinician to manage patients with renal hydatid cysts. External studies are needed to validate this new scoring system in routine clinical practice.

Uretero-duodenal fistula is an uncommon complication in urology. The cause of fistula have been reported as ureteral calculi, iatrogenic injury, trauma and malignancy. The gold standard treatment of uretero-duodenal fistula remains controversial. The most common management is nephrectomy and primary closure of fistula. We report a case of 67 yearold man with uretero-duodenal fistula after laparoscopic correction of ureteropelvic junction obstruction. In the era of minimal invasive management, we decided to use endoscopic and conservative treatment. The definitive treatment will be reconsidered if conservative treatment fails. We will discuss the steps of management and follow-up for this patient.

Urogenital fistulas are common complication of obstetric and gynecological surgery; the most common are vesicovaginal fistulas. Vesicouterine fistulas are rare, which explains the difficulties in diagnosis and treatment. The literature review and own clinical case presented in article. A 43-years-old female patient was consulted with complaint of urinary leakage from vagina, which appeared 1 month after the cesarean section and vesicouterine fistula has been diagnosed. Successful laparoscopic treatment of vesicouterine fistula was performed at the Avicenna Medical Center after 3 months. The urethral catheter was removed 7 days after surgery. At control examination after 1, 3 and 6 months, ultrasound examination of the pelvic organs confirmed the consistency of the scar on the uterus. Urination remained free and painless, the patient did not notice urine leakage. This clinical observation shows the possibility of treating a vesicouterine fistula with a laparoscopic approach with a good result and the possibility of early rehabilitation.

Introduction. Renoalimentary fistulas represent infrequent pathology with 27 literature reports. The oldest report is from the year 1953. Nowadays, they usually arise after the cryoablation of renal tumors. In this case, we reported secondary renocolic fistula as an unusual complication of pyonephrosis, as well as the treatment modality, providing a literature review that favors a conservative or minimally invasive approach in most cases of renocolic fistula. Case report. In our case, the patient was a young female with a long course of kidney disease, which eventually led to pyonephrosis with renocolic fistula. Initially, the patient was hospitalized due to life-threatening urosepsis, successfully treated with a conservative approach. Afterward, we decided to proceed with surgical treatment. Regarding the poor right kidney function of the patient and the presence of concurrent sepsis, the right hemicolectomy with primary ileocolic anastomosis and the right nephrectomy were performed. The postoperative course was without complications, and the patient was discharged from the hospital on the 10th day. Follow-up did not reveal any complications. Conclusion. Regarding the available literature, a conservative and minimally invasive approach is most frequently employed in such cases. However, in cases of haemorrhage, sepsis, and impaired kidney function, surgery offers the only chance for cure. In patients with concurrent gastrointestinal pathology, surgery is usually the only option. Kidney preservation should be imperative in all cases, except in the case of impaired kidney function. The laparoscopic approach can be utilized in selected cases.

We aim to design a new glanuloplasty procedure combined with spongiosum to reduce the incidence of glans dehiscence and coronal fistula after proximal hypospadias repair. Patients who underwent urethroplasty by dorsal preputial island flap for proximal hypospadias between January 2014 and December 2016 were reviewed in this retrospective cohort study. Those who underwent spongiosum-combined glanuloplasty comprised the new-maneuver group, whereas those who underwent conventional glanuloplasty comprised the control group. The incidence of complications was then compared. In the new-maneuver group, dysplastic corpus spongiosum alongside lateral Buck's fascia (0.3–0.4 cm wide) on both sides of the urethral plate was separated from the proximal normal spongy tissue, joining into the glans wings to increase tissue volume and covering the neourethra in the glans penis. In the control group, the neourethra was covered with superficial fascia under the coronal sulcus. As a result, the new-maneuver and control groups comprised 47 and 28 patients, respectively. In the new-maneuver group, no glans dehiscence was detected; however, two (4.3%) patients had coronal fistula, two (4.3%) had urethral stricture, and four (8.5%) had diverticulum. In the control group, two (7.1%) patients had glans dehiscence, eight (28.6%) had coronal fistula, four (14.3%) had urethral stricture, one (3.6%) had diverticulum, and one (3.6%) had penile curvature recurrence. The new-maneuver group had less incidences of coronal fistula (P < 0.001), glans dehiscence (P = 0.033), and urethral stricture (P = 0.008) but had a higher incidence of diverticulum than the control group (P = 0.040). It clearly demonstrates that spongiosum-combined glanuloplasty can significantly reduce the incidences of coronal fistula and glans dehisce.

OBJECTIVE: To compare the successful outcome of flap versus no-flap in O’Conor & Sokol technique for simple vesicovaginal fistula (VVF) repair. METHODS: This quasi-experimental study was conducted in department of Urology, Institute of Kidney Diseases, Hayatabad Medical Complex Peshawar, Pakistan from March 2015 to December 2019. During this study period, 64 eligible patients, selected through non-probability convenient sampling technique were assigned to two Groups. Group A included 34 patients who underwent VVF repair through O’Conor & Sokol technique without interposition flap while Group B comprised of 30 patients with VVF repair with interposition flap. Patient getting completely dry with no urinary incontinence at primary endpoint of 6 months was labelled as successful outcome. All the pre-operative, per-operative and post-operative data was collected on structured proforma and analyzed on SPSS version-21. RESULTS: The mean age of the patient was 33.8±7.8 years in group A and 35±6.3 years in group B. About 76.5% (n=26/34) patients in group A and 80% (n=24/30) patients in Group B developed VVF due to obstetrical trauma. Overall, O’Conor and Sokol technique of VVF repair was successful by curing urinary incontinence in 95.3% (n=61/64) patients. Successful outcome for O’Conor & Sokol technique was achieved in 94.1% (n=32/94) patients in Group A and 96% (n=29/30) patients in Group B, at 6 months of follow-up (p>0.05). CONCLUSION: There is no significant difference between interposition flap and no-flap in outcome of simple VVF repair through O’Conor & Sokol technique. The decision of interposition can be individualized depending upon preference of surgeon.

Purpose: We compared the protective effect of additional tunica vaginalis flap coverage combined with a dartos flap against urethrocutaneous fistulas in tubularized incised plate (TIP) urethroplasty in a randomized controlled trial. Materials and Methods: This prospective, randomized controlled trial in a single tertiary center enrolled 50 patients in whom it was feasible to perform single TIP urethroplasty between 2016 and 2017. Consecutive children were randomly allocated to study group A (additional tunica vaginalis flap coverage, n=25) or control group B (dartos-only coverage, n=25). All patients were examined in the outpatient clinic at 1, 3, 12, and 24 months. Postoperative cosmetic outcomes were evaluated by surgeons and parents using the Pediatric Penile Perception Scale questionnaire. Results: In group B, 1 of 25 patients (4.0%) developed an urethrocutaneous fistula within 12 months. An additional two cases of fistula were found in all proximal-type hypospadias patients at 24 months in the same group without statistical significance (p=0.07). The penile cosmetic satisfaction rate was not significantly different between the groups according to scores on the Pediatric Penile Perception Scale. Conclusions: Our randomized controlled trial did not show a significant decrease in the incidence of or a significant slowing of the progression of postoperative fistulas after TIP urethroplasty by the use of additional tunica vaginalis coverage. A tunica vaginalis flap is not routinely recommended but could have a selective role in proximal-type TIP urethroplasty with deficient dartos and subcutaneous tissue to cover the neourethra.

A 69-year-old woman with changes secondary to pelvic radiotherapy presents repeated episodes of massive hematuria associated with double J catheter replacements. After several imaging tests, an uretero-arterial fistula is confirmed by angiography and treated with a coated stent. Uretero-arterial fistula poses a diagnostic challenge, requiring a multidisciplinary approach through clinical suspicion and interventional procedures.

We present a rare case demonstrating successful endovascular management of an arterioureteral fistula involving the abdominal aorta. Arterioureteral fistulas are rare but life-threatening, with mortality rates ranging from 7% to 23%. Early recognition and prompt management are essential for preventing catastrophic consequences, including hypovolemic shock. However, recognition of an arterioureteral fistula requires a high index of clinical suspicion due to its rarity and the lack of a sensitive diagnostic method. Arterioureteral fistulas could be induced by traumatic events in patients who have a history of pelvic surgery, radiation, and prolonged placement of a ureteral stent. Endovascular stent graft placement could be a valid treatment option for arterioureteral fistulas involving the abdominal aorta.

Abstract Background The angiogenesis inhibitor monoclonal antibody Bevacizumab is presently the standard treatment for numerous neoplasms but particular toxicities are emerging, such as hypertension, haemorrhage, thromboembolism, gastrointestinal perforation, fistulae, and delayed wound healing. The addition of Bevacizumab to radio and chemotherapy has improved the overall survival rate in patients with metastatic, persistent or recurrent cervical carcinoma. However an increased risk of enteric or urinary fistula formation has been documented, related to hypoxia which is induced by the inhibition of angiogenesis. Moreover, previous pelvic surgery, repeated ureteral stenting and radiation are additional risk factors. Case presentation We describe the remarkable case of a right ureteral stent displacement inside the rectum lumen in a patient treated with Bevacizumab for pelvic recurrence of cervical cancer. The patient was referred to our Urology Department with urinary sepsis and bilateral hydronephrosis. Right ureteral stent substitution was planned; at cystoscopy the distal loop of the stent was not visualized inside the bladder. The presence of the distal loop of the right ureteral inside the rectum was clearly demonstrated with a CT scan. Conclusions Since Bevacizumab is increasingly used in the treatment of gynaecological neoplasms and indwelling ureteral stents are often required to treat or prevent ureteral compressions, similar cases are likely to be diagnosed and this complication should be considered in the management of advanced pelvic cancers.

Abstract Background The presence of urinary fistula after ileal conduit urinary diversion is a challenging complication, and this study investigated the role of the intra-conduit negative pressure system (NPS) in the presence of urinary fistula following ileal conduit (IC) urinary diversion as a conservative treatment. Methods Using the intra-conduit NPS, a minor drainage tube was placed within a silicon tube to suck urine from the conduit with consistent negative pressure. Patients with urinary fistula following IC from August 2012 to July 2017 were recorded, and the clinical characteristics and outcome were retrospectively analyzed. Results The intra-conduit NPS was used as a primarily conservative treatment for 13 patients who suffered from urinary fistula and presented with a large amount of abdominal/pelvic drainage without other significant morbidities. The median age was 60 years old (42–74 years), and 7patients were male. The median duration between the IC operation and the presence of urinary fistula was 15 days (2–28 days), and elevated creatinine levels were detected in the abdominal/pelvic drainage with a median level of 2114 μmol/L (636–388 μmol/L). A significant decrease in abdominal/pelvic drainage was identified in 12 patients. The median time that the NPS was used was 9 days (7–11 days). The other patient did not show any improvements after 2 days of observation and then underwent open surgery. With ureteral stenting, 2 abdominal drainage tubes and the intra-conduit NPS were placed during operation, no urine leakage was observed in the abdominal/pelvic field, and the patient was cured in 9 days. With a median follow-up of 22 months, no fistula recurrence or hydronephrosis was detected. Conclusion The intra-conduit negative pressure system is a feasible and promising way to cure urinary fistula following ileal conduit urinary diversion. Because this procedure is a mini-invasive and simple approach, it might represent an alternative in selected patients.

Urinary fistula is a rare but severe complication which could occur after radiation therapy for prostate cancer (PCa). We describe the case of an inner thigh urinary fistula in a patient treated with radical prostatectomy and adjuvant radiation therapy for PCa. A 76-year-old man presented to the emergency room complaining of right thigh swelling, pain and fever. Computed tomography scan and urethra-cystography showed bladder-neck leakage and fluid collection, extended from the pelvis to the right inner thigh. Patient was treated with ultrasound-guided drainage and intravenous antibiotics. Timely diagnosis and treatment are necessary in order to reduce possible evolution to necrotizing fasciitis.

Introduction: Percutaneous treatment of persistent urinary fistula after partial nephrectomy using N-butyl-2-cyanoacrylate and gelatin sponge (Spongostan®) is an effective and relatively non-invasive procedure that should be considered when a conservative approach fails. Three successful cases of percutaneous embolization by using N-butyl-2-cyanoacrylate have been reported in the literature. To our knowledge, the use of Spongostan for the treatment of urinary fistula after partial nephrectomy has not been previously described. Case report: We present the case of an 82-year old man who underwent percutaneous closure of a urinary fistula following partial nephrectomy by using gelatin sponge (Spongostan®) and N-butyl-2-cyanoacrylate. Conclusions: We encourage the use of this technique in selected cases. Collaboration amongst urologists and skilled interventional radiologist is strongly recommended.

Aim: Male patients with anorectal malformations (ARM) are classified according to presence and level of the recto-urinary fistula. This is traditionally established by a preoperative high-pressure distal colostogram that may be variably interpreted by different surgeons. The aim of this study was to evaluate the inter- and intraobserver variation in the assessment by pediatric surgeons of preoperative colostograms with respect to the level of the recto-urinary fistula.Materials and Methods: Sixteen pediatric surgeons from 14 European centers belonging to the ARM-Net Consortium twice scored 130 images of distal colostograms taken in sagittal projection at a median age of 66 days of life (range: 4–1,106 days). Surgeons were asked to classify the fistula in bulbar, prostatic, bladder-neck, no fistula, and “unclear anatomy” example. Their assessments were compared with the intraoperative findings (kappa) for two scoring rounds with an interval of 6 months (intraobserver variation). Agreement among the surgeons' scores (interobserver variation) was also calculated using Krippendorff's alpha. A kappa over 0.75 is considered excellent, between 0.40 and 0.75 fair to good, and below 0.40 poor. Surgeons were asked to score the images in “poor” and “good” quality and to provide their years of experience in ARM treatment.Results: Agreement between the image-based rating of surgeons and the intraoperative findings ranges from 0.06 to 0.45 (mean 0.31). Interobserver variation is higher (Krippendorff's alpha between 0.40 and 0.45). Years of experience in ARM treatment does not seem to influence the scoring. The mean intraobserver variation between the two rounds is 0.64. Overall, the quality of the images is considered poor. Images categorized as having a good quality result in a statistically significant higher kappa (mean: 0.36 and 0.37 in the first and second round, respectively) than in the group of bad-quality images (mean: 0.25 and 0.23, respectively).Conclusions: There is poor agreement among experienced pediatric colorectal surgeons on preoperative colostograms. Techniques and analyses of images need to be improved in order to generate a homogeneous series of patients and make comparison of outcomes reliable.

Newly developed transrenal ureteral occlusion self-expanding metallic stents (SEMSs) are applied in patients with inoperable fistulas. In this study, the occlusive properties of M- and D-type occlusion SEMSs were investigated in 3D-printed phantom and ex vivo porcine urinary tracts. In the former, the mean bursting pressure causing leakage of contrast medium through the occlusion SEMS was relatively higher in M-types (42.8 ± 3.8 mmHg) than in D-types (38.8 ± 3.8 mmHg), without a statistical difference (p = 0.075). In the latter, the bursting pressure causing leakage through the M-type occlusion SEMS (110.7 ± 8.6 mmHg) was significantly higher than that of the D-type occlusion SEMS (93.8 ± 11.2 mmHg, p = 0.015); however, the mean bursting pressures causing contrast blowout did not differ between the two types (178.7 ± 11.2 mmHg vs. 176.2 ± 11.8 mmHg, p = 0.715). In conclusion, M- and D-type occlusion SEMSs showed similar efficacy in occlusive properties in the 3D phantom study; however, the M-type was superior in the ex vivo porcine urinary tract model. Further in vivo experimental studies are required to confirm these experimental results.

Urinary fistulas complicating treatment of pelvic tumors are the clinical diagnostic problem that needs research and decision. The top-priority radiological method for diagnostic urinary fistulas is computed tomography. About application magnetic resonance imaging (MRI) is less well knows. The possibilities MRI to diagnostic of urinary fistulas are illustrated in the article; we discuss the limitation of method requiring additional use of other radiological methods. A literature search on the topic of research was carried out on the databases PubMed and eLIBRARY.

The aim of this study is to report a case of acute ureterovaginal fistula (UVF) formation with immediate symptomatic presentation after transvaginal ultrasound-guided oocyte retrieval (TVOR) for in vitro fertilization (IVF) and to perform a systematic literature review of ureteral injuries during TVOR. A 33-year-old woman with a history of anovulatory infertility presented with severe abdominal pain and vaginal leakage immediately following TVOR for IVF. We systematically reviewed the current literature regarding ureteral injury resulting from TVOR and present a case of timely identification and management of a UVF followed by a successful pregnancy. Computed tomography cystogram with intravenous contrast and left retrograde pyelogram confirmed the diagnosis of UVF which was managed by placement of the left ureteral stent. The IVF cycle was converted to a freeze-all cycle. The ureteral stent was removed 4 weeks later, and a subsequent frozen embryo transfer cycle resulted in pregnancy. We present the 13th case of ureteral injury and the fourth case of UVF following TVOR. UVF formation is a rare complication after TVOR and may result in serious long-term morbidity if it is not identified and treated promptly. Clinicians must exercise a high degree of suspicion and prompt evaluation for potential ureteral injuries in women presenting with abdominal pain, urinary symptoms, or vaginal leakage following TVOR.

Pubic bone osteomyelitis is a rare infectious condition which is characterized by a complex diagnostic and therapeutic workup, due to its various clinical manifestations. Among the many causes of this condition, urinary fistula is the most common in case of previous urological procedures. In order to solve this complication, it is crucial to treat both the fistula and (moreover) the infectious locus arising from it, because treating the fistula alone does not provide any control on the infectious noxa. We present the first case of pubic bone osteomyelitis arising from a urinary fistula after a robotic radical cystectomy with intra corporeal continent neobladder, which has been successfully treated through a multidisciplinary approach.

Desmoid tumors are rare benign tumors with aggressive fibroblastic proliferation. Although desmoid tumors do not metastasize, they have locally aggressive features and can cause a urinary fistula. Here, we report a case of a 35-year-old woman with Gardner syndrome who was diagnosed with an intra-abdominal desmoid tumor 1 year previously and who presented with a newly developed cystic mass lesion on a computed tomography scan. The cystic mass lesion was clinically diagnosed as an urinoma from the right ureterotumoral fistula; thus, surgical resection of the mass lesion was planned. However, Tc-99m diethylenetriamine pentaacetic acid renal scintigraphy revealed bilateral ureterotumoral fistulas; hence, the treatment plan was changed to conservative management.

Urological complications after kidney transplantation is still now one of the main reasons of worsening operation results. Most surgeons pay a lot of attention to the urinary fistulae. At verifiable urinary fistulae the next tactics significantly depends on the presence of urinary stent. Subject of the work: to study the effectiveness of implantation as for double J-stents at kidney transplantation for prophylaxis of urinary fistulae. Materials and methods. The analyzed results of kidney transplantation among 66 patients from 2012 to 2016. There were 37 (56.1 %) men, the average age of patients was 33.4±12.4 years. All the patients on early after surgical period were done the monitoring of clinic-biological indexes, ultrasonic examination with scanning of renal allograft. As for the aim of the work all the patients were divided into two groups: The main group included 35 (53 %) recipients with kidney allografts, everyone of them was set uretero-bladder anastomosis on the double J-stent during the period from 11.2013 to 06.2016. The average age of patients was 32.6±9.2 years, there were 17 (48.6 %) men, 18 women (51.4 %). Controlling group involved 31 (47 %) patients. During the period from 01.2012 to 10.2013 at kidney transplantation urinary stents were not used among the patients. The average age of recipients was 34.3±15.3 years, there were 20 (64.5 %) men, 11 women (35.5 %). Results. According to the analysis of our clinic material the implantation of J-stent at kidney transplantation for prophylaxis of urinary fistulae is reliably (p0.05) with the infection of urinary tracks with the presence of urinary stent. Conclusions. Implantation of J-stent is effective and safe method of surgical prophylaxis of urinary fistulae and it can be routinely applied at kidney transplantation.

Ureteral fistula is a serious complication of abdomino-pelvic surgeries, often resulting in poor outcomes owing to lack of proper treatment. We report the case of a 49-year-old woman who underwent placement of a silicone-covered ureteral occlusion stent in her right ureter for the management of ureteral leakage after pelvic surgery. A ureterogram obtained 18 months following the stent placement confirmed that there was no stent migration or additional urine leakage. We propose that the silicone-covered ureteral occlusion stent is practical, fast, and safe for the management of ureteral leakage.

Spontaneous nephrocutaneous fistula is a rare manifestation of renal diseases. The majority of such fistulas are associated with xanthogranulomatous pyelonephritis, chronic renal tuberculosis, complicated renal stones, and post-traumatic or surgical injuries. We report the case of a 58-year-old male who presented with a history of massive lumbar cutaneous purulent discharge for 3 years. More investigations with ultrasonographic study and magnetic resonance imaging demonstrated the presence of a fistula between the kidney and skin. Detailed laboratory workup was negative for the diagnosis of renal tuberculosis. This patient was considered as a rare variant of xanthogranulomatous pyelonephritis and was managed effectively with a simple nephrectomy.

Purpose To compare retrograde dye injection through an externalized ureteral catheter with direct needle injection of dye into proximal ureter for identification of unrecognized collecting system disruption and integrity of subsequent repair during open partial nephrectomy. Materials and Methods We retrospectively reviewed the records of 259 consecutive patients who underwent open partial nephrectomy. Externalized ureteral catheters were placed preoperatively in 110 patients (Group 1); needle injection of methylene blue directly into proximal ureter was used in 120 patients (Group 2). No assessment of the collecting system was performed in 29 patients (Group 3). We compared intraoperative parameters, tumor characteristics, collecting system entry and incidence of urine leaks among the three groups. Results The mean tumor diameter was 3.1cm in Group 1, 3.6cm in Group 2, and 3.8 cm in Group 3 (p = 0.04); mean EBL 320cc, 351 cc and 376cc (p = 0.5); mean operative time 193.5 minutes, 221 minutes and 290 minutes (p < 0.001). Collecting system entry was recognized in 63%, 76% and 38% of cases in Groups 1, 2 and 3 respectively. (p = 0.07). Postoperative urine leaks requiring some form of management occurred in 11 patients from group 1 and 6 from group 2. (p = 0.2). No patient in Group 3 developed a urinary leak. Conclusions Identification of unrecognized collecting system disruption as well as postoperative urine leak rate in patients undergoing partial nephrectomy were not influenced by the intraoperative technique of identifying unrecognized collecting system entry. Postoperative urine leaks are uncommon despite recognized collecting system disruption in the majority of patients.

OBJECTIVES: urinary fistula is a morbid complication after renal transplantation leading to graft losses and patient death. We review and update our data on urinary fistula after renal transplantation and the outcome after surgical and conservative management. MATERIALS AND METHODS: the charts of 1046 renal transplants were reviewed. Transplants were performed through an extended inguinotomy; vascular anastomoses to the iliac vessels and urinary reconstruction accomplished through the Gregoir technique. Fistulae were diagnosed by urinary leaks through the incision or by the occurrence of a collection in the iliac fossa. Patient was treated surgically or conservatively according to the characteristics of the fistula and patient clinical status. RESULTS: Thirty one fistulae were diagnosed (2.9%). Twenty nine leaks due to ureteral necrosis and 2 due to reimplantation fault. The incidence of leaks among cadaver and live donor transplants was 3.22% and 2.63%, respectively (p = 0.73). Among diabetic and non diabetic patients the incidence of urinary leaks was 6.4% and 2.6%, respectively (p = 0.049). Treatment consisted in anastomosis of the graft ureter or pelvis with the ureter of the recipient in 17 cases with success in 13 (76.5%). Prolonged bladder drainage was employed in 7 cases and the fistula healed in 4 (57%). Ureteral reimplantation was performed in 3 cases and did not work in any of them. Ureteral ligature plus nephrostomy was employed in two cases and worked in one (50%). Percutaneous nephrostomy and ureteral stenting with double J catheter were employed in one case each and worked in both. CONCLUSIONS: The anastomosis of the graft ureter with the ureter of the recipient is a good method for treating urinary fistulae after renal transplantation when local and systemic conditions are good. Ureteral ligature associated to nephrostomy should be applied in cases of unfavorable local conditions or clinically unstable patients.

INTRODUCTION: The traditional delayed treatment of iatrogenic complete ureteral obstruction is open surgery. An easy endourological technique, transluminal re-canalization of the ureter by guide-wire puncture under fluoro-endoscopic control, which has been performed on 4 patients, is described. SURGICAL TECHNIQUE: With the guidance of C-arm fluoroscopy, by moving the C-arm to different planes, the tip of the ureteroscope is directed to the correct plane to meet the obliterated proximal end of the ureter and under direct vision, transluminal puncture is performed using the stiff end of a 0.035-inch guide wire. Once the stiff end of the guide-wire is in the lumen of the proximal ureter, an ureteral catheter is introduced over the guide wire, the guide wire is then removed and reinserted through the ureteral catheter with its soft end leading and a double J catheter is inserted. Ureteral stricture, if later encountered, is treated with balloon dilatation. RESULTS: Continuity of the ureter was restored in all 4 patients. The double J stents were removed 6 weeks later and a retrograde pyelography revealed resolution of the hydronephrosis without extravasation of urine. CONCLUSION: Although a very satisfactory result was achieved in our cases, more cases are needed to show if it can be an alternative to conventional surgical repair. However, we believe that this minimally invasive technique can be used for short obliterated ureteral segments and neither delays nor does it preclude further management using open surgery.

No Abstract

INTRODUCTION: Nephrobronchial fistula is a rare complication of xanthogranulomatous pyelonephritis, a disease that can fistulize to lungs, skin, colon and other organs. CASE REPORT: A 37-year old patient presented a chronic history of lumbar pain and thoracic symptoms such as cough, dyspnea and oral elimination of pus. Patient went to several services and was submitted to 2 thorax surgeries before definitive treatment (nephrectomy) was indicated. After nephrectomy, the patient presented an immediate improvement with weight gain (8 kg / 1 month) and all his symptoms disappeared. CONCLUSION: This clinical case illustrates the natural history of nephrobronchial fistula, the importance of clinical history for diagnosis and the relevance of early treatment of renal lithiasis.

ABSTRACT Vesicouterine fistula is a rare condition. Its incidence, however, has been increasing due to the higher incidence of cesarean sections. The presence of a live fetus inside the bladder who passed through a vesicouterine fistula is an extremely rare situation. We report a case of woman who underwent two previous cesarean sections, was referred to a hospital due to mild pelvic pain and genital bleeding. At the moment, physical examination was normal. Ultrasound scan revealed a gestational sac inserted into the anterior wall of the uterus, with a living fetus of approximately 13 weeks, with active body movement and normal heart rate inside it. The fetal abdomen, around the waist, was stuck at the opening of a vesicouterine fistula, so that the fetal head and trunk were entirely into the bladder cavity, while lower limbs remained at the uterine cavity. Laparotomy was performed, the fistulous tract was excised, the fetus (without heart beating) was removed on opening the bladder, and the uterine cavity was emptied. The defects in the bladder and uterus were repaired. The postoperative period was uneventful. A live fetus inside the urinary bladder is a rare condition the continuation of pregnancy is unlikely and the vesicouterine correction can be made by the time of surgical intervention.