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Introduction: Arterioureteral fistulas are rare, life-threatening, and difficult to diagnose. Risk factors are medical interventions in the lesser pelvis (general, urological, gynecological, and vascular surgery), radiation therapy of the lesser pelvis, permanent double J catheters, and previous vessel malformations., Materials and Methods: We retrospectively evaluated all cases of arterioureteral fistulas registered over the last 10 years in the clinic's documentation system. For all cases, clinical symptoms, diagnostics, therapies as well as clinical outcome were evaluated., Results: Four of the 5 patients were women. The most common initial symptom was a gross hematuria (4/5). All patients had a permanent double J catheter after extensive surgery of the lesser pelvis. In one case the initial diagnosis was done by retrograde ureterography, in 2 patients by provocative angiography and in the other 2 cases with a laparotomy due to cardiovascular problems. Three patients were treated by open surgery and 2 patients were treated by stenting of the iliac artery. One patient died, 2 patients had a permanent kidney fistula, and 2 patients continued treatment with a permanent double J catheter., Conclusion: Based on the more aggressive therapy regimens, we expect that the number of patients presenting with arterioureteral fistulas will continue to rise. The identification of these patients based on their risk profile is essential.

Introduction:  Abnormal links between the arterial system and other luminal systems are a challenge to those in charge of their adequate diagnostic and therapeutic management., Objective:  Scientific case report on an individual who underwent successful treatment combining vascular-surgical and interventional radiology techniques for a rare right uretero-iliac artery fistula based on personal clinical experience, a selective literature research and a detailed discussion of current recommendations for diagnostic workup and subsequent treatment., Case Characteristics:  A 79-year-old patient was admitted with haematuria : and bladder tamponade : in the presence of bilateral actinic ureteral strictures secondary to neoadjuvant radiochemotherapy followed by abdominoperineal rectum exstirpation due to suprasphincteric rectal cancer (ypT3ypN0M0). Laboratory tests revealed anaemia; transabdominal ultrasound demonstrated bilateral urinary retention. A complementary CT scan did not reveal any manifest bleeding resulting from intermittent haemorrhage., Surgical Procedure:  Initially, the bladder haematoma was removed and ureteral catheters were changed. Due to endoluminal bleeding in the right ureter, a combined procedure was initiated, involving a vascular-surgical approach (access to the right femoral artery, ultimate disobliteration and intimal refixation in the right superficial femoral artery due to dissection) and an interventional radiology approach (insertion of an Amplatzer [AMPLATZER™Vascular Plug II; St. Jude Medical, Saint Paul, Minnesota, USA] into the right internal iliac artery and iliac stenting by a cross-over manoeuvre from the left femoral access site) although no acute bleeding was detected in the CT scan (but acute haemorrhage from the right ureteric ostium was confirmed during cystoscopy)., Clinical Course:  The patient stabilised in due time in response to periinterventional treatment in the ICU. He was discharged on the 15th day after surgery without evidence of recurrent haemorrhage., Summary:  In the presented case, this promptly initiated (vascular-surgical and interventional radiology) hybrid operation was absolutely indicated, being the approach with the best prospects for recurrent arterial bleeding with clinical manifestation of haematuria and haemorrhage within the urinary bladder due to a uretero-iliac artery fistula., Conclusion:  Today, a minimally invasive approach with stenting is the method of choice in the sequential, urgent management of a potentially life-threatening uretero-iliac fistula in the presence of arterial endoluminal bleeding and an imminent haemorrhagic shock., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Radiotherapy plays a substantial role in the treatment of malignancies. More than 2/3 of all oncologic patients undergo radiotherapy during their specific treatment. Besides manifold side effects of radiotherapy, radiogenic fistulas of the urogenital tract are a potential severe complication. These fistulas might affect the female genital tract and the urinary tract., Therapy: Potential manifold variety of radiogenic urogenital fistulas requires a specific therapy. Radiation tissue damage includes severely disturbed local blood supply. Consequently, in some cases extremely complex reconstructive techniques are necessary to restore the functionality of the urinary tract., Conclusion: The treatment of radiogenic urogenital fistulas is challenging. A successful therapy can only be achieved by local improvement of the blood supply in the damaged area.

Purpose: The technique of active urinary endoscopic vacuum therapy (uEVT) is described. The surgical technique is demonstrated in detail with the help of a video of the operation and which is available online. Vesical fistulas are a rare complication following rectal surgery. The EVT technique is a novel method for treatment of gastrointestinal leakage. This endoscopic procedure has been adapted to treat a large bladder defect after abdominoperineal resection of the rectum with urine flowing out of the perineal wound., Material and Method: A new open-pore film drainage (OFD) catheter with an external diameter of only a few millimeters has been developed and is constructed from a very thin open-pore double-layered film and a drainage tube. The OFD was inserted into the bladder by means of flexible endoscopy and channeled out through a suprapubic incision. Continuous suction was applied with an electronic vacuum pump to actively drain the urine completely. A passive catheter drainage of urine from the renal pelvis via transurethral single J stent was carried out simultaneously during the complete duration of treatment. The healing process was monitored during and after therapy by intravesical endoscopy., Results: The application of continuous negative pressure via the OFD resulted in total collapse of the bladder. The urine in the bladder was actively and permanently drained through the OFD. Urine leakage from the perineal wound stopped immediately after induction of suction. After 18 days of treatment with the uEVT the bladder defect was healed. After therapy and removal of the catheters the patient had normal micturition., Conclusion: A novel small-bore OFD has been developed for EVT. The OFD technique now allows endoscopic application of negative pressure in the bladder. This first successful experience proves uEVT to be a potent interventional alternative in the treatment of bladder defects.

Although ureteroarterial fistulas are rare, they result in a high mortality because of the massive urogenital haemorrhage. The diagnosis is often difficult even when invasive measures are applied. Including the ureteroarterial fistula in the diagnostic process in cases of macrohaematuria with a positive medical history can be helpful. A ureteroarterial fistula typically develops in pa-tients who have undergone pelvic surgery and radiation as well as after long-term ureteral stents. Patients are usually multimorbid. The treatment of choice consists of fistula exclusion by stent graft deployment in the iliac artery and application of a ureteral stent or a ureterostomy. The significance of surgical treatment is diminishing. The long-term results of endovascular treatment, however, are inconsistent because of stent infections and recurrent bleeding. Therefore, close patient surveillance and cooperation among the treating specialists is necessary.·, (© Georg Thieme Verlag KG Stuttgart · New York.)

Acute wound healing is a dynamic, interactive process culminating in the closure of a tissue defect. Chronic wounds result when the healing cascade is impaired. Proteases destroy important growth factors and matrix proteins, inflammation is prolonged, and the normal healing process does not take place within the expected time span. Owing to demographic changes the investigation of age-related pathologies, including treatment-resistant wounds, has become increasingly important. The TIME concept (tissue, infection, moisture imbalance, edge of wound) assesses essential elements in the healing process that can be addressed in the treatment of chronic wounds. Moist wound treatment is standard therapy. Definitive research trials on the level of success that can be achieved with different dressings are still needed. New types of treatment should be selected with due consideration for clinical variables, the patient's quality of life and independence, and cost effectiveness.

Iliac-ureteral fistulas (IUF) are a rare but potential life threatening event and an important cause of gross hematuria. We report on three cases of IUF. In all cases, prior chronic ureteral stenting, extended pelvic surgery or pelvic irradiation had been performed. Diagnosis was confirmed with angiography in one case, in the others a CT scan revealed the IUF. Treatment included surgical exploration with local reconstruction, extra-anatomical bypass and nephrectomy with arterial patch repair. The increasing incidence of IUF is a consequence of an increasing number of advanced and extended pelvic operations, radiation therapy and long-term ureteral stenting. Diagnosis should be made by provocative angiography or CT. Treatment options vary depending on the site and morphology of the local situation, but morbidity and mortality is still high due to delayed adequate diagnosis and treatment. A conclusive algorithm should be followed for the successful management of IUF.

One hundred and nineteen transrenal occlusions of 77 ureters were carried out in 71 patients. Thirty-one ureters were occluded by means of glue and in 21 Gianturco coils were introduced at the same time. Forty-six ureters were occluded by means of disposable silicone-filled latex balloons. Seventeen out of 31 ureters treated with glue (55%) and 32 out of 46 ureters with balloons (70%) were permanently occluded. On 42 occasions, re-occlusions had to be carried out, the average period from the initial occlusion being 2.5 weeks for glue and 19.5 weeks for balloons. In nine out of the 119 ureteric occlusions (7.5%), there were mild complications; these were easily treated and were of no consequence to the patient.

Forty-six benign ureteric stenoses in 42 patients were cannulated anterogradely and dilated. In 37 cases, balloon dilatation was carried out followed by a temporary insertion of a ureteric stent. Seven long stenoses were treated by continuous stenting, with a double pigtail stent. In two patients surgery had to be performed following percutaneous catheterisation and dilatation. Seven restenoses were due to tumour recurrences and lymph node metastases; apart from this, the success rate of balloon dilatation was 63%. The patients were observed for one to 41 months with an average of 14 months. Uncomplicated traumatic stenoses and fistulae were successfully treated with only one exception. Prognostically unfavourable features were devascularized ureteric segments, advanced scarring and very long stenoses.

From 1968 to 1977, 21 patients were observed who had fistulas between the bowel and the urinary tract. Except in five patients, fistulas were located vesicointestinally. The main etiologic factors were inflammatory lesions of the bowel, especially diverticulitis and appendicitis. All patients had symptoms relating to the urinary tract, mainly recurrent urinary infection with dysuria. On the average, nine months passed until the fistula was diagnosed. Urethrocystoscopy proved to be the most valuable aid in diagnosing intestinovesical fistulas, the fistulous opening was thus seen in 11 patients. Thirteen patients were treated by operation and eight by conservative treatment only. In the conservatively treated group, two fistulas healed spontaneously. Fistulas based on diverticulitis from the sigma were treated using a multiple stage procedure. No complications were observed.

Conservative treatment with long lasting success is possible in many cases of ureteral lesions of different etiology, esp. after complications with gynecological surgery. Both fistulas and stenoses of the ureter can be treated conservatively by placing long term indwelling PVC ureteral splints ("endoprothesis") of FR 8 or 10 with smooth surface and without hooks or the like to keep them place. In a considerable number of cases such treatment is a true and even superior alternative to open surgery with its consecutive longer lasting hospitalization, because it can be done as outpatient-care and, of course, has a lower rate of complications.

The results obtained from treatment of 156 patients for ureterovaginal fistula are reported in this paper. Eighty-five per cent of the fistulae had developed in the wake of gynaecological operations. Vaginography played a major role in diagnosis. Spontaneous occlusion of fistulae occurred in 19 cases. Satisfactory results were recorded from nine patients by means of indwelling ureteral catheters. Cases of ureteral stenosis were tackled by means of corticosteroid therapy. Nephrectomy was necessary in 24 cases. A date between five and seven weeks from fistulation has proved to be the optimum time for ureteroplasty. Organ-saving operations were performed on 101 patients. Results were satisfactory in 82.1 per cent of all cases. This assessment is given with due consideration of renal function.

A report is given on a case of ureterocutaneous fistula in consequences of a stenosis of the pelvic ureter, successfully treated by transcatheter embolization of the left kidney. The embolization was preferred to nephrectomy because of the poor clinical condition of the patient. Butyl-2-Cyanoacrylate has been found to be a suitable embolization material.

In 285 renal transplantations, performed during the years 1967-1978, 6 ureteral obstructions (2,1%) and 15 urinary fistulas (5,3%) were observed. Ureteral obstructions occurred in the late phase after transplantation and were caused by strictures at the uretero-vesical anastomosis (two patients), compression of the ureter by enlarged kidney during rejection (one patient) resp. lymphocele (one patient) and strictures at the pyelo-ureteral junction (two patients). Satisfactory results were achieved by surgical treatment in all patients. Urinary fistulas occurred in the early postoperative phase. Two vesical, 12 vesico-ureteral and one calyceal fistula were observed. 7 fistulas (1 vesical, 6 vesico-ureteral) closed spontaneously after temporary drainage of the bladder. 8 fistulas were repaired surgically. While satisfactory results were obtained in 13 patients, two patients died due to infection and sepsis after reoccurrence of fistulas.