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Genito-urinary fistula describes an abnormal connection between an epithelial surface of the female genital tract and the urological tract. The UK incidence is 100–120 cases per year with the majority caused by iatrogenic injury during pelvic surgery, most commonly involving the bladder. Women describe continuous vaginal leakage of urine. If the bladder fistula is diagnosed within 6 weeks of the index injury conservative treatment with an indwelling catheter on free drainage is recommended. Surgical repair ideally is performed by vaginal approach, with the abdominal approach reserved for ureteric fistula. Surgery is best performed in one of the high volume supra-regional fistula centres. [ABSTRACT FROM AUTHOR]

Point pratique sur la stratégie thérapeutique de la prise en charge des fistules urétro-rectales (FUR) après traitement de cancer de prostate localisé. Analyse de la littérature (PubMed, Cochrane Database) des articles en langue anglaise et française portants sur les FUR. Les FUR après prise en charge de cancer de prostate sont rares. Le bilan paraclinique (cystoscopie, uréthrocystographie, IRM pelvienne) permet de les classer en simple et complexe. Les FUR complexes, de diamètre > 2 cm, les antécédents d'irradiation, les sepsis à répétition et la fécalurie sont des facteurs de mauvais pronostic. Le traitement conservateur ne doit pas excéder 3 mois et fait appel à une dérivation urinaire, parfois associée à une dérivation digestive en cas de présence de plusieurs facteurs de mauvais pronostic. La voie trans périnéale semble apporter les meilleurs résultats chirurgicaux et de bons résultats fonctionnels. La prise en charge des FUR peut être initialement conservatrice. La prise en charge chirurgicale doit être discutée avec le patient en prenant en compte son état général et les résultats escomptés. Practical point relating to the management of rectourethral fistula (RUF) after localized prostate cancer treatment. Review of literature (PubMed, Cochrane Database) of articles in French and English regarding RUF. RUF after localized prostate cancer treatment are rare. Paraclinical examinations (cystoscopy, uretrocystography, RMI) permit the classification between simple and complex. Complex RUF, of > 2 cm diameter, history of irradiation, repetitive sepsis, fecaluria, are poor prognosis factors. A conservative approach may not exceed 3 months, and consist in a urinary diversion, sometimes associated with a digestive one in case of several poor prognosis factors. The trans perineal approach seems to have the best surgical results, and favorable functional outcomes. RUF management may initially be conservative. Surgical treatment must be discussed with the patient in the light of his general condition and the expected outcomes. [ABSTRACT FROM AUTHOR]

Due to the close anatomical proximity of urological system to the female reproductive system, iatrogenic urological complications are common in gynecological surgeries. These complications may have devastating consequences with significant long-term sequelae. Therefore, all pelvic surgeons should be familiar with the ways to manage and prevent such complications. In this article, we provide an evidence-based review and highlight the recent updates in the aetiology, incidence, risk factors, diagnosis, and management of bladder, ureteric and urethral injuries following gynecologic surgery. [ABSTRACT FROM AUTHOR]

The use of barrier layers between the neourethra and skin is associated with lower rates of post-operative urethrocutaneous fistula (UCF) following hypospadias surgery. Recent studies have evaluated the ability of biologic adjuvant urethral coverings (BAUCs) – namely acellular matrix (AM), tissue adhesives (TAs), and autologous platelet-rich plasma or fibrin (PRP/PRF) – to prevent wound complications following hypospadias surgery. In general, however, these studies are small and conducted at single institutions. To assess the effect of BAUCs on the rate of UCF following single-stage primary hypospadias repair. We conducted a systematic review of studies reporting the rate of postoperative UCF in pediatric patients undergoing single-stage, primary hypospadias repairs using either AM, TA, or PRP/PRF as a layer interposed between the neourethra and skin. We then performed a pooled proportional meta-analysis of post-operative UCF. Patients within each study who underwent comparable surgery but did not receive a BAUC were used as controls. 10 studies were included in our review. The meta-analysis included 280 patients from 7 studies who underwent hypospadias repairs with BAUCs. The pooled incidence of UCF was 10% (95% CI 6–14%). Mean follow-up ranged 5–23.5 months in the 5/7 studies reporting specific durations, and ≥6 month and 14–30 months, respectively, in the other two studies. Patients in whom a BAUC was used had significantly lower odds of UCF than control patients (OR 0.39, 95% CI 0.24–0.64, p = 0.0002). In subgroup analyses, significant superiority held for AM and TA; proximal or penoscrotal cases; transverse preputial island flap (TPIF) technique; when both cases and controls had local flaps; and when neither cases nor controls had flaps. The use of BAUCs was associated with decreased rates of post-operative UCF in single-stage primary hypospadias repairs and may be most beneficial in more severe cases and when used in addition to local flaps or when using a flap is not possible. In 2/3 studies of PRP/PRF and 2/4 studies of tubularized incised plate (TIP) technique, dartos flaps were used in controls but not BAUC patients, which may explain the lack of benefit demonstrated for these subgroups. This meta-analysis is limited by the quality of evidence in the included studies, which are not uniformly randomized. Furthermore, the follow-up durations and methods for assessing complications are not standardized between included studies. The meta-analysis herein suggests that using BAUCs may reduce UCF rates following hypospadias surgery. Rigorous prospective evaluation is needed to validate this benefit. [ABSTRACT FROM AUTHOR]

Background: To present the complications of free-flap phalloplasty in three-staged female-to-male transgender surgery. Methods: This retrospective study included patients who underwent a three-staged free-flap phalloplasty for female-to-male transgender surgery between January 1988 and December 2013. Data regarding demographics, operative techniques, and complications were collected and analyzed. Results: A total of 101 patients with a mean age of 30.2 years were included. Phalloplasty with traditional free forearm tube-intube fasciocutaneous flap was performed in 25 (24.8%) patients, free forearm fasciocutaneous flap with vaginal mucosa for a prefabricated urethra in 30 (29.7%) patients, free radial forearm osteocutaneous flap with vaginal mucosa for a prefabricated urethra in 22 (21.8%) patients, and free fibula osteocutaneous flap with vaginal mucosa for a prefabricated urethra in 24 (23.8%) patients. Complication rates of partial flap loss, urethrocutaneous fistula, urethral stricture, and hair or stone formation were 12.9%, 49.5%, 24.8%, and 5.0%, respectively. Patients receiving fibula osteocutaneous flap phalloplasty had the lowest overall complication rate (33.3%), followed by those with radial forearm osteocutaneous flap (40.9%), forearm fasciocutaneous flap (43.3%), and forearm tube-in-tube fasciocutaneous flap (80.0%). Forearm tube-in-tube fasciocutaneous flap procedure was associated with significantly higher rates of overall complications (p = 0.05), urethrocutaneous fistula (p = 0.005), and hair or stone formation (p = 0.002) compared with the other three types of procedures. Rates of all complications did not significantly differ among fibula osteocutaneous flap, radial forearm osteocutaneous flap, and forearm fasciocutaneous flap procedures. Conclusion: In free-flap phalloplasty for female-to-male transgender surgery, utilization of free fibula osteocutaneous flap with vaginal mucosa for a prefabricated urethra resulted in the lowest complication rate. Further comparisons among different procedures of phalloplasty are warranted. [ABSTRACT FROM AUTHOR]

Purpose: Arterio-ureteral fistula (AUF) is an uncommon diagnosis, but increasingly reported and potentially lethal. This systematic review comprehensively presents risk factors, pathophysiology, location and clinical presentation of AUF aiming to increase clinical awareness of this rare but life-threatening condition, and to put this entity into a contemporary perspective with modern diagnostic tools and treatment strategies. Materials and Methods: This review was performed according to the PRISMA (Preferred Reporting Items for a Systematic Review and Meta-Analysis of Individual Participant Data) guidelines. A literature search in PubMed( and EMBASE was conducted. In addition, retrieved articles were cross-referenced. Data parameters included oncologic, vascular and urological history, diagnostics, treatment, and followup, and were collected using a standard template by 2 independent reviewers. Results: A total of 245 articles with 445 patients and 470 AUFs were included. Most patients had chronic indwelling ureteral stents (80%) and history of pelvic oncology (70%). Hematuria was observed in 99% of the patients, of whom 76% presented with massive hematuria with or without previous episodes of (micro)hematuria. For diagnosis, angiography had a sensitivity of 62%. The most predominant location of AUF was at the common iliac artery ureteral crossing. AUF-specific mortality before 2000 vs after 2000 is 19% vs 7%, coinciding with increasing use of endovascular stents. Conclusions: AUF should be considered in patients with a medical history of vascular surgery, pelvic oncologic surgery, irradiation and/or chronic indwelling ureteral stents presenting with intermittent (micro)hematuria. A multidisciplinary consultation is necessary for diagnosis and treatment. The most sensitive test is angiography and the preferred initial treatment is endovascular. [ABSTRACT FROM AUTHOR]

Background: Obstetric fistula is a major maternal health issue with its attendant physical, psychosocial, and economic correlates. The morbidity worsens with physical challenges associated with neurological and musculoskeletal injury in the patient. Objectives: The major objective of this study was to examine selected clinical characteristics and determinants of obstetric palsy among patients with obstetric fistula. Study Design: Descriptive retrospective study. Methods: Medical records of 452 patients who were treated for obstetric fistula at the National Obstetric Fistula Centre, Abakaliki, from January 2014 to May 2018 were retrieved and analyzed for clinical characteristics and clinical determinants using the SPSS for Windows (SPSS version 20). Results: Results revealed that 23.5% of the subjects neither registered for nor attended antenatal care in a health facility. While 50.9% of the subjects had lived with fistula for less than a year, 31.4% lived with obstetric fistula between 1 and 9 years. Labor lasting for 2 days or more was reported by 46.7%. Vaginal births were reported by 34.1%. Intracervical fistula was the most frequently encountered fistula. Maternal obstetric paralysis of one or both lower limbs was found in 31.4% of the subjects. Results of a binary logistic regression model also reveals that antenatal care, duration of labor, mode of delivery, and circumferential fistula were significant determinants of obstetric palsy among patients with obstetric fistula. Conclusion: There is need to increase public enlightenment and make antenatal care and delivery readily available to reduce obstetric fistula and maternal obstetric palsy. Therapists' awareness of these determinants also aids in clinical diagnosis, prognosis, and prevention. [ABSTRACT FROM AUTHOR]

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 FROM AUTHOR]

Introduction and Objectives. Bilateral renal tumors have a rare occurrence, accounting for 1% to 4% of patients with renal cell carcinoma (RCC). Partial nephrectomy (PN) is the first option for treating patients with RCC especially in elective settings. While open PN is still indicated in difficult centrally located or large renal tumors, the laparoscopic approach can be as effective in standard cases. Prostate cancer (PCa) is the second most common cancer in men, accounting for 15% of all the diagnosed cancers. Laparoscopic radical prostatectomy (LRP) is a viable alternative to open prostatectomy. The aim of this paper is to present our management of a patient with bilateral renal tumors and prostate cancer. Materials and Methods. We present the case of a 65 years old patient, who was referred to our clinic for elevated PSA levels. On ultrasonography and CT examination the patient was diagnosed with a 22 mm right and 21 mm left renal tumors. Prostate biopsy at a PSA of 5 ng/ml showed acinar adenocarcinoma, Gleason score 7 (4+3), stage cT2b, classified as localized intermediary risk. The treatment strategy was to perform staged bilateral 3D LPN and then 3D LRP. Firstly we approached right kidney, then one month later the left. After another month we performed LRP, using an extraperitoneal technique. Results. We performed LPN on both sides. The operative time was 130 minutes, respectively 140 minutes, and warm ischemia time was 22 minutes, respectively 24 minutes. No major complications and no urinary fistula were encountered in the postoperative setting. Blood loss was approximately 150 ml. All surgical specimens had a minimum 1 mm safety margin of healthy renal tissue. The patient was discharged on the 4th postoperative day. The histopathological examination revealed: RCC on the right side and oncocytoma on the left. For the LRP operative time was 3.5 hours. Blood loss was 250 ml, without intraoperative complications or incidents. The Foley catheter was removed on the day 11th postoperative day. No urinary fistula was encountered in the postoperative course. The patient was discharged on the 4th day after surgery. Conclusions. In selected cases 3D LPN represents a safe and efficient alternative to open surgery in the management of renal tumors and offers earlier recovery for the patients with less pain and shorter convalescence. LRP offers similar oncologic and functional results as ORP in localized selected cases. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Iatrogenic urological injuries during gynaecological surgery can have devastating consequences and significant long-term sequelae. Timely recognition of injury and appropriate investigation and treatment, whether in the acute or delayed setting, are vital in reducing the potential impact of subsequent complications to both patient and doctor. In this review, we will describe the aetiology, diagnosis and management of ureteric, bladder and urethral injuries in both the acute and delayed setting, with a special focus on urogenital fistulas in women in order to facilitate a better understanding of what can be done to minimize iatrogenic injury to the urinary tract and the optimal management of these complications when they do occur. [ABSTRACT FROM AUTHOR]

Purpose We assessed the effect of performing colpectomy before (primary) or after (secondary) gender affirming surgery with single stage urethral lengthening on the incidence of urethral fistula in transgender men. Materials and Methods We retrospectively reviewed the charts of all transgender men who underwent gender affirming surgery with urethral lengthening between January 1989 and November 2016 at VU University Medical Center. Patient demographics, surgical characteristics, fistulas and fistula management, and primary and secondary colpectomy were recorded. Descriptive statistics were calculated and incidence rates were compared. Results A total of 294 transgender men underwent gender affirming surgery with urethral lengthening. A urethral fistula developed in 111 of the 232 patients (48%) without colpectomy and in 13 of the 62 (21%) who underwent primary colpectomy (p <0.01). Secondary colpectomy resulted in 100% fistula closure when performed in 17 patients with recurrent urethral fistula at the proximal urethral anastomosis and the fixed part of the neourethra. Conclusions Primary colpectomy decreases the incidence rate of urethral fistulas. Secondary colpectomy is also an effective treatment of fistulas at the proximal urethral anastomosis and the fixed part of the neourethra. [ABSTRACT FROM AUTHOR]

Background Congenital urethroperineal fistula is an extremely rare anomaly in which a second channel rises from the prostatic urethra and opens onto the perineum. This entity resembles the hypospadiac type of urethral duplication, but resection of the ventral channel is simple and curative. Case A 4-year-old healthy boy had a small pimple on his perineum that yielded a small amount of whity discharge. Discharge occurred every one month for three years. The patient had no history of incontinence or urinary tract infection. Physical examination revealed a small opening to the median perineal raphe below the scrotum. Voiding cystourethrogram showed a normal urethra but no fistula was demonstrated. Fistulography failed due to closure of external orifice at the small pimple. MRI revealed abnormal sagittal tract from the pimple to the prostatic urethra. A circular incision was made around the pimple and the dissection was performed along the fistula. The fistula was ligated. Histopathologic examination of the fistula revealed that it was lined with squamous epithelium. Two months after surgery, incision of the abscess was performed. He has been well with 8 months postoperatively. Conclusion Simple resection of the ventral channel of the urethroperineal fistula is curative. While both are rare entities, differentiation to the hypospadiac type of urethral duplication is crucial for definite treatment. [ABSTRACT FROM AUTHOR]

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 니rin이na from the right 니reterotumoral fistula; th니s, surgical resection of the mass lesion was planned. However, Tc-99m diethylenetriamine pentaacetic acid renal scintigraphy revealed bilateral ureterotumoral fist니las; hence, the treatment plan was changed to conservative management. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose We report our experience with the diagnosis and treatment of women with urinary fistula after mid urethral sling surgery. Materials and Methods We retrospectively reviewed the records of patients with urinary fistula secondary to mid urethral sling surgery. Electronic medical records and billing records were searched. We analyzed sling type, presenting symptoms and interval from initial sling surgery to 1) symptom appearance, 2) fistula diagnosis and 3) fistula repair. Symptomatic outcomes were assessed by PGI-I. Surgical outcomes were based on history and examination. Results We identified 10 women with a mean age of 58 years (range 37 to 70). Mean interval from mid urethral sling surgery to symptom onset, diagnosis and fistula repair was 2, 16 and 18 months, respectively. Mean followup was 26 months (range 4 to 96). There were 1 ureterovaginal, 1 enterovesical, 6 vesicovaginal and 7 urethrovaginal fistulas. Patients presented with stress urinary incontinence (70%), unaware incontinence (50%), overactive bladder (40%), pelvic pain (30%) and voiding symptoms (20%). Nine women underwent fistula repair and 1 underwent continent urinary diversion. A Martius flap was used in 6 of 9 patients, an omental flap and a bladder wall flap were used in 2 each, urethral reconstruction and ureterocolovesicostomy were performed in 1 each and 7 received an autologous pubovaginal sling. Seven patients (78%) underwent successful fistula repair. A successful symptomatic outcome was achieved in 5 of 7 women with stress urinary incontinence, 3 of 5 with unaware incontinence, 3 of 4 with overactive bladder, 2 of 3 with pelvic pain and 2 of 2 with voiding symptoms. Conclusions With careful attention to surgical principles and technique, including removal of as much of the adjacent mesh as possible, a successful outcome can be achieved in most patients with a fistula secondary to mid urethral sling surgery. [ABSTRACT FROM AUTHOR]

A 3-year-old Ugandan boy presented with 18 months of constipation and 12 months of pneumaturia and fecaluria. Physical exam revealed abdominal distension and a palpable mass anterior to the rectum. Previous contrast enema had been non-diagnostic, and a voiding cystourethrogram (VCUG) had confirmed a recto-urethral fistula. After surgical evaluation, a computed tomography (CT) scan suggested colonic duplication, and a laparotomy was performed for rapidly progressive bowel obstruction. A tubular colonic duplication with fecal impaction was found, necessitating fecal disimpaction and a double divided colostomy. Two months later at re-laparotomy, the septum between the duplicated colonic lumens was found to extend proximally to the mid transverse colon and distally to the upper rectum, and was divided. No urethral fistula was identified, and the colostomy was recreated. At a third operation, the colostomy was reversed. The patient is well at one-year follow up, without evidence of recurrent fistula or stricture. This case shows that colonic duplication in children can be an elusive diagnosis. Often, a variety of radiographic studies may be needed and may be difficult to interpret. In cases with colo-urinary fistula, the fistula may respond to fecal diversion without requiring operative repair. Management in a resource-limited setting can still yield positive outcome. [ABSTRACT FROM AUTHOR]

Purpose: The literature on secondary surgery after hypospadias repair is limited. We determined risk factors for secondary surgery via a population based approach. Materials and Methods: We used a hospital consortium database to identify a population that underwent hypospadias repair in 2009 and 2010. Specifically meatal advancement and glanuloplasty, distal, proximal and perineal hypospadias repairs were evaluated. Secondary surgeries performed between 2009 and 2011 were captured and the variables of age at primary surgery, insurance, region and surgeon volume were measured. Mixed effects logistic regression analysis was used to analyze independent variables associated with secondary surgery. Results: We identified 5,326 subjects who underwent primary hypospadias repair by 114 surgeons at 47 hospitals in 2009 and 2010. Distal hypospadias repair is associated with a 9% secondary surgery rate. After adjusting for other factors every additional 10 distal repairs that a surgeon performed yearly was associated with a 29% decreased risk of requiring fistula, stricture or diverticulum repair. There were regional differences for secondary surgery following meatal advancement and glanuloplasty and distal repairs. Finally, each additional year of patient age at distal repair was associated with a 15% increased risk of requiring secondary cystoscopy and a 21% increased risk of requiring urethral dilation/incision. Conclusions: This population based study produced significantly different results than small studies of select patients and techniques. Distal hypospadias repair is associated with a 9% secondary surgery rate. Low surgeon volume independently increases the risk of fistula, stricture or diverticulum repair. Increased patient age at primary distal hypospadias repair increases the risk of cystoscopy and urethral dilation/incision. [Copyright &y& Elsevier]

Abstract: Tubular colonic duplications are rare malformations and its association with prostatorectal fistula is extremely rare with only one case reported to date. We report the successful management of an 8 year old child with communicating tubular colonic duplication with prostatorectal fistulae. Tubular colonic duplications may be difficult to diagnose due to varied presentations, therefore a high degree of suspicion should be present while managing children with isolated congenital recto urinary fistulas. [Copyright &y& Elsevier]

Abstract: Background: The wide spectrum of circumcision urethral injury/fistula makes selection of appropriate repair methods challenging in sub-Saharan Africa. This paper reports on the outcome of repair-oriented categorization in a Nigerian center. Methods: Consecutive children presenting with circumcision urethral injury/fistula at the University of Benin Teaching Hospital were categorized into six repair-oriented groups in 2009–2011. Results: 21 children were treated. Except in 2 cases, early neonatal circumcision at an average age of 8 days (range 4–14 days) had been performed, the majority (52%) by paramedics at home. Categories of injury/fistula based on severity ranged from isolated fistula (38%) which required fistula excision and repair (category A) to severe ventral urethral/coronal/glanular avulsion (29%) which required urethral plate tubularization/ventral penile reconstruction (category F). Overall, successful first-stage repair was achieved in 19 (91%) children. Meatal stenosis (2), urethral stricture (1), which responded to serial dilatation, and minor urinary leakage (2), which was closed at second stage, were the post-repair complications. Adequate penile size and straight penis on erection were achieved in all cases. Cosmetic outcome was excellent in 16 (76%) cases, good in 4 (19%) and fair in 1 (5%). Conclusion: Repair-oriented categorization, which could be useful to practitioners in similar settings, was satisfactory in managing urethral injury/urethrocutaneous fistula. [Copyright &y& Elsevier]

Purpose: The rectal sphincter preserving transperineal approach has been increasingly used successfully. We analyzed our experience with this surgical approach. A secondary aim was to evaluate the surgical outcome of energy ablative rectourethral fistulas without a concomitant interposition muscle flap. Materials and Methods: We identified all patients with rectourethral fistula who underwent rectal sphincter preserving transperineal repair from 1998 to 2011. Re-approximation of the urethral mucosa, posterior anastomotic urethroplasty or partial/total prostatectomy with urethrovesical anastomosis was performed for urinary closure. The fistula cohort was divided into 2 groups, including postoperative and energy ablative fistulas, respectively. Success after perineal rectourethral fistula repair was defined as resolution after the first attempt at repair. Results: A total of 23 patients underwent rectal sphincter preserving, transperineal rectourethral fistula repair. In the postoperative fistula cohort the fistula was successfully resolved in all 10 patients. A dartos interposition muscle flap was used in 2 of 10 patients. In the energy ablative cohort the fistula was successfully closed in 8 of 13 patients. An interposition muscle flap was not placed in 8 patients with an energy ablative fistula, of whom success was achieved in 5. Two of the 5 patients with an energy ablative fistula and a successful outcome without a concomitant interposition muscle flap had urinary extravasation, necessitating temporary catheterization. Conclusions: Rectal sphincter preserving transperineal repair is a successful surgical method to repair postoperative and energy ablative rectourethral fistulas. An interposition muscle flap should be considered in the setting of energy ablative rectourethral fistulas to increase successful outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Study Objective: To evaluate urologic complications after colorectal resection for endometriosis. Design: Cohort study (Canadian Task Force classification II-2). Setting: Tertiary referral university hospital and expert center in endometriosis. Patients: One hundred sixty-six women with colorectal endometriosis proven by transvaginal sonography and magnetic resonance imaging. Intervention: Open or laparoscopic colorectal resection for endometriosis. Measurements and Main Results: Forty-four patients (26.5%) experienced at least 1 urologic complication, including infection. Eight patients (4.8%) experienced postoperative symptomatic hydronephrosis requiring ureteral stent in 3 cases, a percutaneous nephrostomy in 1 case, and expectant management for the last 4. Urologic fistulas occurred in 5 patients (3%). Postoperative voiding dysfunction requiring self-catheterization was observed in 48 patients (28.9%). With univariate analysis, a relationship was found between voiding dysfunction and partial colpectomy (p = .001) and American Society of Reproductive Medicine total score (p = .02), and between the occurrence of urinary fistula and the use of prophylactic ureteral catheterization (p = .015) and parametrectomy (p = .02). A relationship was found between postoperative symptomatic hydronephrosis and the use of prophylactic ureteral catheterization (p = .003). Conclusion: Colorectal resection for endometriosis can lead to urologic complications, particularly for patients requiring partial colpectomy, of which patients need to be informed. [Copyright &y& Elsevier]

Abstract: Background: An iatrogenic ureterovaginal fistula (UVF) can be a consequence of difficult pelvic surgery. The patient must endure a long wait before having major surgery to reconstruct the injured ureter. Reports that address the minimally invasive treatment of UVF are limited, and are reviewed here. We introduce the concept of using a Memokath™ 051 stent (PNN A/S, Hornbaek, Denmark) as a promising minimally invasive approach for UVF. Methods: We used PubMed, Science Direct, Google and the Cochrane Library to assemble appropriate evidence-based reference reports. The keywords used for the search were: ‘Memokath’, ‘stent’; ‘ureterovaginal fistula’ and ‘ureteral injury’. The review showed 42 relevant articles published up to September 2011. Results: Ureteric stenting consistently stopped the vaginal leak of urine. The long-term results were not encouraging after removing the JJ stents at 3months after insertion. Most patients had a recurrence of the vaginal leak of urine. The outcome was different with the Memokath stent, that remained in situ for a duration far exceeding that of the JJ stent. The Memokath stopped the vaginal leak of urine with no episodes of urinary tract infection and no evidence of stent migration. Conclusion: Long-term ureteric stenting has two advantages, in that it facilitates urine flow through the ureteric strictured segment down to the bladder, and it stops urine leakage along the fistula. It further promotes the resolution of the ureteric stricture and healing of the fistula. A duration of 3months was inadequate when a JJ stent was used, whereas longer periods are possible with the Memokath stent. The optimum stenting period required for complete healing of a UVF remains to be defined. Long-term Memokath ureteric stenting can be an effective alternative and minimally invasive approach to conventional surgical repair in selected cases. [Copyright &y& Elsevier]

The article presents a case study of a five-year-old female dog that was presented in the hospital with a history of congenital urinary incontinence. The physical examination revealed complex urogenital defects including urethrovestibular, vestibuloperineal fistule, and penoclitoris. The article discusses the treatment which included vaginectomy with urethral reconstruction.

We reviewed literature examining predictors of urinary fistula repair outcomes in developing country settings, including fistula and patient characteristics, and perioperative factors. We searched Medline for articles published between January 1970 and December 2010, excluding articles that were (1) case reports, cases series or contained 20 or fewer subjects; (2) focused on fistula in developed countries; and (3) did not include a statistical analysis of the association between facility or individual-level factors and surgical outcomes. Twenty articles were included; 17 were observational studies. Surgical outcomes included fistula closure, residual incontinence after closure, and any incontinence (dry vs wet). Scarring and urethral involvement were associated with poor prognosis across all outcomes. Results from randomized controlled trials examining prophylactic antibiotic use and repair outcomes were inconclusive. Few observational studies examining perioperative interventions accounted for confounding by fistula severity. We conclude that a unified, standardized evidence-base for informing clinical practice is lacking. [ABSTRACT FROM AUTHOR]

Purpose: Vesicovaginal fistula is a socially debilitating problem with important psychological and medicolegal implications. Complicated fistulas include large fistulas or those with failed prior repair attempts. The key to successful closure of such fistulas is the use of adjuncts such as a Martius, peritoneal or omental flap. Small intestinal submucosa is an acellular collagen matrix graft that is nonimmunogenic, biodegradable and ready to use off the shelf. We evaluated small intestinal submucosa as an interposition patch during complicated vesicovaginal fistula repair. Materials and Methods: A total of 23 women with a mean age of 33.5 years who had a complicated vesicovaginal fistula were enrolled in this clinical trial. Complicating factors were failed primary repair in 9 cases, excessive perifistulous scarring in 4 patients and a fistula 1.5 cm or greater in the remainder. Transvaginal repair was done in 7 low fistula cases and transabdominal repair was done in the remainder with a high fistula. A small intestinal submucosa patch was interposed in all cases at classic abdominal or vaginal repair. All patients were evaluated 1, 3 and 6 months postoperatively. Results: All patients who underwent vaginal repair were dry during followup. Of the 16 women who underwent transabdominal repair 14 were dry. The overall success rate was 91.3%. No reported allergic or inflammatory reactions were documented. Conclusions: Using small intestinal submucosa as an interposition layer at anatomical vaginal and/or transabdominal repair of complicated vesicovaginal fistulas seems to be a simple, feasible solution. [Copyright &y& Elsevier]

Abstract: Objective: To retrospectively assess early postoperative complications in augmentation cystoplasty without preoperative mechanical bowel preparation (MBP). Material and Methods: Between May 1987 and May 2006, 162 cystoplasties were performed in 158 children. The segments used were: sigmoid colon (81.5%), ileum (13%), and ileocecum (5.5%). The mean age was 8.65 years (range 2.1–22.7 years). No preoperative MBP of any kind was used in any of the patients and all of them received antibiotics preoperatively and postoperatively. Results: No intraoperative complications related to the procedure were reported. The mean hospital stay was 9.48 days (range 4–30 days). The mean time to intake of oral fluids was 94.77h (range 48–288h). Postoperative complications occurred in 9.87%: urinary fistula was the most common (2.4%); only 3 patients presented wound infection (1.85%); 5 patients required reoperative surgery (hemoperitoneum, patch necrosis and 3 cases of urinary peritonitis); 1 patient presented an intra-abdominal abscess that resolved with antibiotic treatment. Conclusions: Preoperative MBP can be omitted in children that require augmentation cystoplasty without an increased risk of infectious or anastomotic complications. Further prospective, randomized clinical trials should be carried out in order to validate our findings in the pediatric population. [Copyright &y& Elsevier]

Purpose: Epididymo-orchitis is a devastating complication of imperforate anus. Without proper treatment the condition may result in infertility. Nevertheless, the exact etiology and optimal management of epididymo-orchitis in anorectal malformation are unknown. Materials and Methods: Retrospective review of our hospital records between 1997 and 2010 identified 6 cases of epididymo-orchitis in 82 boys with anorectal malformation. Extensive search of the literature revealed 35 additional cases. Clinical details of these 41 patients were analyzed using chi-square testing. Results: Epididymo-orchitis occurred predominantly (86%) in high or intermediate anorectal malformation with rectourinary fistula. Median age at onset of epididymo-orchitis was 6 months and there was no side predilection. Urinary tract infection was noted in 54% of patients. Persistent mesonephric duct syndrome (27%), urethroejaculatory duct reflux (22%), vasovesical ectopia (10%), neurovesical dysfunction (34%) and urethral stricture/stenosis (17%) were frequently associated risk factors for epididymo-orchitis. In 73% of patients epididymo-orchitis recurred with exclusive antibiotic treatment. Diverting colostomy was ineffective in preventing epididymo-orchitis. Division of rectourinary fistula was curative in 36% of patients, while in 34% epididymo-orchitis recurred even after division of rectourinary fistula. Division of rectourinary fistula is likely to resolve epididymo-orchitis in the absence of additional risk factors. Vasectomy was required in 22% of patients to prevent recurrence. Conclusions: In addition to rectourinary fistula, urinary reflux into the vas deferens and neurovesical dysfunction are major risk factors for epididymo-orchitis in anorectal malformation. Division of rectourinary fistula is curative in only a third of cases. In the remaining cases some form of surgical disruption of the vas deferens is needed to resolve recurrent epididymo-orchitis. [Copyright &y& Elsevier]

Abstract: Purpose: To evaluate the efficacy of fibrin sealant for repair of urethrocutaneous fistula after multiple failed hypospadias and epispadias surgeries. Materials and methods: The study population comprised 11 boys (mean age 12.18 years) with history of hypospadias or epispadias and at least two failed fistula repair operations leading to recurrent urethrocutaneous fistula. During the operation, single-donor fibrin glue, either from the patient (7) or a parent (4), was applied over the suture lines and beneath the skin. A urethral catheter was kept in place for 7–10 days. Follow up ranged from 6 to 24 months (mean 12.63 months). Results: Nine patients had an uneventful postoperative course. In one patient with a large fistula, partial wound dehiscence occurred. In another patient with complete hypospadias, hematoma formation caused skin dehiscence but the urethra remained intact. Both cases recovered after 6 months with no further intervention. No fistula recurrence was reported during follow up. Conclusion: Single-donor fibrin glue could be a useful adjunct to surgical management of patients after multiple failed attempts at hypospadias or epispadias fistula repair. Moreover, this product improves the safety margin regarding the risk of disease transmission. [Copyright &y& Elsevier]

Purpose: The American Academy of Pediatrics recommendation is to perform hypospadias repair at age 6 to 12 months. However, our patient population included a significant proportion of patients in adolescence and beyond undergoing primary repair. We report a comparison of outcomes in patients in different age groups. Materials and Methods: We prospectively report on patients with distal hypospadias who underwent primary repair at our institution during 7 months. Study parameters included age, degree of hypospadias, surgical technique and the complications rate. Results: A total of 61 patients were included in analysis. All cases underwent repair using the tubularized incised plate technique. More proximal hypospadias and different repair techniques were excluded from study. Patients were classified by age, including group 1–25 (40%) 6 months to 2 years old, group 2–17 (28%) 2.2 to 3.7 years old and group 3–19 (32%) 4 years old or older. Only 6 patients (9.8%) had postoperative complications and all were in groups 2 and 3. In group 2 there were 3 complications (17.6%), including loss of repair, meatal stenosis and hematoma in 1 case each. In group 3 there were 3 cases (15.8%) of postoperative fistula. The fistula incidence was higher in group 3 (p = 0.032). Conclusions: Despite previous reports suggesting a much higher incidence of complications in older children the complication rate is within the acceptable range for infant hypospadias repair in some series. However, these complications were statistically significantly different between the older groups when compared with the recommended age group under American Academy of Pediatrics guidelines. [ABSTRACT FROM AUTHOR]

Purpose: Urethral stricture is the second most common complication of hypospadias repair after urethrocutaneous fistula. Usually more than 1 procedure is needed for correction due to a lack of available tissue after previous repairs. We evaluated 1-stage urethral stricture management after hypospadias repair using a ventral buccal mucosal graft. We describe the importance of graft hanging and coverage. Materials and Methods: From August 2004 to April 2009, 15 patients 9 to 17 years old underwent urethral stricture repair after failed hypospadias surgery. Mean time after primary surgery was 7.2 years (range 4 to 13). Vascularized periurethral tissue around the stenotic part of the neourethra was dissected. The urethra was opened ventrally and a buccal mucosal graft of appropriate size was inserted to allow urethral augmentation. Using several U stitches the graft was anchored to the surrounding periurethral tissue to prevent its folding and retraction. Recurrent chordee in 12 patients and secondary vesicoureteral reflux in 3 were also corrected at this time. Results: Mean followup was 37 months (range 17 to 73). Successful results were confirmed in all patients by urethrography and uroflowmetry. One urethral fistula was corrected 3 months later by minor surgery. Recurvature did not develop in this group. There was no recurrent reflux in endoscopically treated patients. Conclusions: Ventral buccal mucosal grafting is a simple, safe option for urethral stricture repair. Hanging the graft to periurethral tissue is important for its survival and to prevent postoperative folding and retraction. [ABSTRACT FROM AUTHOR]

Purpose: We hypothesized that a stratified analysis, where measures of association between dartos flap coverage and fistula formation were adjusted by segregation into 2 strata according to stent insertion, would help better define the dartos flap-urethrocutaneous fistula association. Materials and Methods: We retrospectively reviewed 153 consecutive boys with distal hypospadias who underwent tubularized incised plate repair by a single pediatric urologist between 2000 and 2005. Fistula rate was analyzed separately according to patient age, stenting and dartos flap coverage using univariate and multivariable analyses, and checking for effect modification/interaction. Results: Mean ± SD age at surgery was 16.5 ± 12.8 months and followup was 17.0 ± 11.6 months. Nonstented tubularized incised plate repair was performed in 88 patients (58%) and dartos flap coverage in 118 (77%). Urethrocutaneous fistula developed in 19 patients (12%). Nonstented repair (p = 0.003) and absence of dartos flap coverage (p <0.001) were significantly associated with higher fistula rates. In children without stent a significant increase in fistula rate was observed when dartos flap coverage was not used (9% vs 37%, p = 0.002; OR 0.16, 95% CI 0.05–0.51). In boys who underwent stent placement the fistula rate also increased in the absence of dartos flaps, from 2% to 25% (p = 0.12; OR 0.05, 95% CI 0.002–1.0). Conclusions: Dartos flap coverage emerges as an important, clinically identifiable and modifiable risk factor associated with fistula reduction following tubularized incised plate repair for distal hypospadias after adjusting for placement of a urethral stent. Furthermore, stenting is an effect modifier in the association between dartos flap coverage and urethrocutaneous fistula. [Copyright &y& Elsevier]

Abstract: Objective: To evaluate, from the patient''s point of view, long-term urinary and sexual outcome of surgery for severe hypospadias. Patients and method: Patients treated for severe posterior hypospadias during childhood and now aged 20–35 years were included. Outcome was evaluated using the Hypospadias Objective Scoring Evaluation and our own quality of life questionnaire. Results: Of 48 patients, 13 were lost to follow up. The questionnaire was thus sent to 35 patients of whom 27 agreed to answer (77% response rate). Fifteen presented proximal and 12 scrotal hypospadias. Average age at surgery was 3.3 years and the children underwent an average of 3.7 procedures. There were 40% early complications, and 59% late complications, including 33% fistulae and 26% stenosis. At present, 70% of patients have an apical meatus, 82% have a straight penis, 37% present difficulty initiating voiding, and one patient has a persistent fistula; 74% say their penis looks abnormal, either because of the absence of foreskin, penis size or scarring. Sexual and global satisfaction rates, determined using a visual analogue scale, are respectively 68% and 63%. Satisfaction is statistically correlated to the presence of early complications or stenosis, but not fistula. It decreases if the patient thinks his penis is not normal, even if the anatomical result is good. Conclusion: Urinary and sexual outcome is good for most patients though the results are variable. Satisfaction seems more affected by subjective feelings than the anatomical result. [Copyright &y& Elsevier]