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Rectouretral fistulas are a rare disease, but represent an important problem for the patient that suffers them and a challenge for the urologist and colorectal surgeon who has to manage them. A wide review has been performed focusing on etiopathogenic factors, diagnostic and therapeutic options including the analysis of different surgical techniques. PubMed, MEDLINE y EMBASE medical database were searched up to September 2014., (Copyright © 2014 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: Calyceal fistula is a rare complication of renal transplantation that may lead to graft loss. This article reports a case of functional recuperation of a graft that seemed condemned to failure., Methods: 31 year old male patient, submitted to living donor renal transplant, in which was necessary to ligate a superior polar artery found during donor nephrectomy, due to its short length. This resulted in development of a calyceal fistula, unsolved with conservative treatment by percutaneous drainage. A new surgical intervention revealed a large upper pole area of necrotic tissue, corresponding to the obliterated artery irrigation zone., Results: Debridement and calyceal suture were performed and a posterior pyelography confirmed fistula closure. Presently, he is asymptomatic, with stabilized graft function., Conclusion: Calyceal fistulas are complications of difficult resolution. However, the present case demonstrates that with an appropriate treatment it is possible to save a graft with no apparent solution at the first place.

Objectives: To report the clinical characteristics of rectourethral fistula (RUF) after radical prostatectomy (RP) as well as our experience managing them., Methods: We present our experience in the treatment of RUF based on their clinical characteristics and the presence of associated complexity factors. After medical history and physical examination, the diagnostic work up was completed in all cases with urethrograms, cystoscopy and barium enema. From January 2000 to July 2010 we treated 12 patients with RUF. Mean age was 64 years(range 56-74 years). The etiology was open surgery in two cases and laparoscopic surgery in ten. Clinical presentation varied from 4 to 60 days after surgery., Results: In our experience, endoscopic and radiological findings were well correlated. Two fistulae were small-less than 5 mm- on the urethral side of the anastomosis allowing spontaneous closure after conservative treatment. Ten patients had larger fistulas on the bladder side of the anastomosis and/or were associated with complexity factors that required a posterior transsphincteric York-Mason approach for resolution, with good recovery of urinary and fecal continence., Conclusion: The RUF is a significant complication after RP and it is difficult to solve. We propose early reconstructive surgery in large or complex RUF. The posterior transsphincteric York-Mason approach has allowed the repair in all cases.

Objective: To analyze the incidence of urological complications, like fistula and stenosis in our series of 282 renal transplants and their management., Materials and Methods: Between December 1995 and October 2005, 282 adult recipients underwent renal transplant. The most common urological complication was urinary fistula. This complication was observed in 24 cases (8.5%), ureteral stenosis in 18 cases (6.4%) and both of them in 5 (1.7%). The items recorded on these patients included the time to diagnosis, the image technique, the type of ureteral stents and the clinical evolution., Results: Endourologic treatment with percutaneos nefrostomy, double-J catheter and metalic endoprotesis was performed successfully in 76.4% of urinary fistula, in 66.7% of ureteral obstruction and in 60% of patients who developed both of them., Conclusion: Endourologic procedures have replaced open reconstructive surgery in most patients with ureteral obstruction or urinary fistula after renal transplant, because they may offer a definitive treatment with low morbidity.

Fistulas between the orthotopic reservoir and the gastrointestinal tract have low incidence (1.5-2%). Simptomatology is variable, but it's frecuent to find fecaluria. Among 90 new intestinal bladders we show two fistule of new bladder to ileo, with nest postoperatory diagnosis, using retrograde cystografy; one was resolved with next postoperative treatment and the other with open surgery.

Background: Calyceal fistulas are common and difficult to treat after surgery of urinary collecting system., Methods: A 30-year old woman. The fifth day after receiving a cadaver donor renal allograft presented an acute rejection episode; fourteen days later presented an urinoma treated with a percutaneous drainage tube. Five days later surgical exploration was made, lower pole infarction and ischemic necrosis of distal ureter were found. Parcial nephrectomy and neo-ureterovesical anastomosis were performed. Later, an inferior calyceal fistula was evidenced, persisting during several weeks in spite of a percutaneous drainage tube. Under fluoroscopic guidance the fistulous tract was embolized with N-butyl-2-cyanoacrylate., Results: The fluoroscopic control confirmed the total closure of the fistula. After 22 months no reappearance of the fistula, no stenosis has been shown at this level., Conclusions: This is a useful technique for the treatment of calyceal fistulas. This is the first time that N-butyl-2-cyanoacrylate is use in the treatment of a calyceal fistula.

The urinary fistulas are not a frequent problem in our urological rutinary work, being the vesicovaginal ones the most common. However, it will be necessary to know them to be able to diagnose and treat them in the best way. In this article we classificate the different urinary fistulas (uro-gynecologicals, uro-vasculars, uro-cutaneous and entero-urinarys), explaining the possible etiologies and the correct management.

Presentation of case of patient with macroscopic anemic hematuria caused for the presence of a fistula between the external iliac artery and the ureter. After the diagnosis, a treatment with endovascular mangement was made. The arterioureteral fistulae are a very rare entie, which supposes a vital emergency. The diagnosis depend upon the clinical evidences (complementary explorations rarely provide specific findings). Classic treatment is bases on open surgery, while endovascular treatment may be an alternative with less aggressiveness.

Objective: To analyze the clinical indications of double-J ureteral catheters., Methods: The most relevant studies published in the literature since the self-retained indwelling catheter was first described in 1967 are reviewed., Results: The experience and results reported in the most relevant studies are presented., Conclusions: The double J ureteral catheter is essential in urological practice. Although its clinical indications are well-established, its use depends on the urologist's experience in most of the cases.

Evaluation of the characteristics of urogenital fistula with a retrospective study at the clinic of Urology Ginecologica in the Instituto Nacional de Perinatologia between March 1992 to June 1995, information of the location, etiopathogenesis of the disease, urinary tract infection and surgical treatment were obtained form de patients records in the clinic. The etiophatogenesis of the disease was surgical gynecological procedures in 51.1%, and obstetric cause 48.5%; the location were 14 (66.6%) vesicovaginal, 5 (23.5% 0 ureterovaginal and 2 (urethrovaginal). The abdominal approach were in 8 patients and vaginal route in 9, no surgical treatment were 2. Successfully repair fistula were in 80.9%. Urinary tract infections before treatment agreed on the obstetric etiology was 47.6%, and for surgical gynecological procedures 52.2%. There is an increase in the incident of obstetric vesicovaginal fistula, we believe it depends on the patients that we have in de Instituto Nacional de Perinatologia, most of them are obstetric patients.

Six cases of vascular lesion associated with percutaneous removal of renal calculi are described. The lesions had been caused during percutaneous access or ultrasound fragmentation of the stone. Those that had resolved spontaneously have not been included. When vascular injury is suspected during the procedure, the appropriate measures must be taken to resolve the different complications, such as arteriovenous, arteriocaliceal or venocaliceal fistula. Since there is little reference to this subject in the Spanish literature, the experience described herein may be of interest to the urologist who has only recently begun to perform this technique.

Five patients with iatrogenic ureteral injuries are described herein. Two patients had a vesicoureteric fistula and the remaining three patients had obstructive uropathy secondary to ligation with resorbable material during hysterectomy for a benign uterine condition, which spontaneously resolved with conservative management. Classically, the approach of this type of lesion was interventional and careful patient selection afforded the possibility of definitive resolution. US, CT and modern endourological technology have facilitated temporary diversion via percutaneous nephrostomy (or surgery, if the foregoing is not possible) to protect renal function during the process of recanalization of the injured ureter. Furthermore, it permits radiological control of the course and functional assessment of the excretory tract.

Surgical correction is the treatment of choice for urinary fistulas. However, there are circumstances that advise against the use of this approach, basically when patient general condition is poor or life expectancy short; i. e., in the presence of an underlying malignant pelvic disease. In these cases, urinary diversion by percutaneous nephrostomy will suffice, although sepsis or derangement of electrolyte balance may sometimes develop due to the fistulous defect. Occlusion of the pyelo-ureteric junction and percutaneous drainage is a solution that causes no major complications. Two patients who could not be submitted to conventional surgery were treated by the foregoing procedure. Both patients have been followed for more than two years. The first case was a male who had undergone abdominoperineal resection due to carcinoma of the sigmoid colon. He developed stress ulcers, pulmonary thromboembolism, sepsis, paralytic ileus and bilateral ureteral fistula. The second case was an insulin-dependent female diabetic who had previously received radiotherapy to the pelvis. She developed a large vesicocutaneous fistula and public osteomyelitis after drainage of an inguinal abscess. Patient tolerance was good and no major complications were observed. In our view this palliative procedure should be considered in the management of patients with urinary fistula whose life expectancy is short. Its application can be extended to patients with inoperable carcinoma of the bladder or prostate and important symptoms.

The present study reports our experience in the endourological treatment of fistulas of the distal ureter in renal transplant patients. The temporary urinary exclusion or dry technique was effective in 8 of the 10 patients. We advocate the use of this simple and safe technique which achieves excellent results.

Techniques for conservative management of different upper urinary tract pathologies have been widely used in the last decade. Endourological treatment of ureteral fistulas is one of the fields which has developed significantly. Our experience in the management of this condition consists of 9 patients that had been treated from 1983 to the present time. Four of these were in transplanted kidneys. Fistula repair was achieved in 8 cases, although one developed secondary urethral stricture. One patient required open surgical correction. There were no deaths or loss of any renal unit. A mean follow-up of 44 months revealed no complications. We consider this therapeutic modality to be the procedure of choice in patients with ureteral fistulas.

Two patients who had developed a urinary fistula following cutaneous ureteroileostomy are described herein. The foregoing condition was successfully treated conservatively with intermittent aspiration via the stoma. This treatment modality was generally performed using regular periods of application and aspiration pressure. The common complications of cutaneous ureteroileostomy are briefly described. Attention is focussed on urinary fistula, an uncommon complication, and the possibility of resolving the foregoing condition in a short period of time by aspiration via the cutaneous stoma before resorting to endourologic or surgical alternatives.