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Purpose: Genital gender-affirming surgery in transmasculine patients encompasses both metoidioplasty and phalloplasty. Some patients opt to undergo staged phalloplasty by metoidioplasty first (SPMF). The aim of this study was to evaluate whether SPMF is associated with less surgical complications compared with immediate phalloplasty (IP). Methods: Our institutional database was retrospectively evaluated to identify transmasculine patients who underwent SPMF between 2006 and 2020. These patients were matched based on the type of flap (radial forearm free flap vs. anterolateral thigh flap) and for the time period in regard to patients who underwent IP. Both groups were compared on patient characteristics, perioperative and postoperative outcomes. Results: Twenty-seven patients with SPMF were matched with 27 IP patients. Median follow-up after phalloplasty was held, respectively, 32 and 33 months after the intervention for SPMF and IP (p=0.99). There were no significant differences in age, body mass index, and smoking habits between both groups. For SPMF, metoidioplasty required subsequent corrective surgery before phalloplasty in three patients (11%). For SPMF and IP, median operation time was 396 and 410 min (p=0.6), median hospital stay was 16 and 17 days (p=0.5), and median catheter stay was 19 and 20 days (p=0.9). In both groups, 16 patients (59%) needed at least one additional surgical procedure for postoperative complications, urethral complications (stricture, fistula), and/or flap-related complications. Conclusion: In our cohort, complications were not reduced by SPMF. In case metoidioplasty is considered as a step toward phalloplasty, separate morbidity of metoidioplasty must be taken into account. [ABSTRACT FROM AUTHOR]

With the continuous development of robot-assisted technology, Robot-assisted Laparoscopic Partial Nephrectomy (RALPN) has gradually become an optional method for the treatment of Hemorrhage secondary to angiomyolipoma (HSA). However, there are rare clinical reports of the primary RALPN for HSA. Therefore, this research aims to evaluate the efficacy and safety of primary RALPN for HSA. Fourteen patients(six males and eight females), aged 14–56 years, underwent primary RALPN for HSA and were retrospectively analyzed from 2015 to 2023. The initial blood routine examination revealed decreased hemoglobin in all patients, and Contrast-enhanced computed tomography (CT) indicated retroperitoneal hematoma. After correcting shock and electrolyte imbalance through fluid therapy and medical treatment, all primary RALPN procedures were performed with transabdominal access on the side of the Hemorrhage. After tumor resection and hematoma removal with a monopolar Curved Scissor, the absorbable barbed suture was performed for inner and outer running stitches, respectively. Patient demographic information, perioperative characteristics, and functional outcomes were collected and analyzed. The initial tumor size of fourteen patients ranged from 57 to 145 mm, and the RENAL ranged from 7 to 11. All of the HSA was controlled, and primary RALPN was successful. The operating time it was ranged from 105 to 265 min. Postoperatively, one patient exhibited chylous drainage (Clavien-Dindo II), and another patient developed pleural effusion (Clavien-Dindo III). No postoperative transfusion and Digital Subtraction Angiography (DSA) highly selective embolization of the bleeding vessel was needed. No patients developed urinoma or urinary fistula. Within the follow-up period, the overall complications were manageable. Primary RALPN is a safe and effective procedure for HSA, which may be considered an alternative to selective renal artery embolization. [ABSTRACT FROM AUTHOR]

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.

INTRODUCTION: Bladder exstrophy-epispadias complex is a rare condition that necessitates numerous surgical procedures during a patient's youth to achieve adequate urine storage and continence. This study aimed to identify the specific needs and functional challenges faced by adults who underwent pediatric bladder exstrophy reconstructions and assess the management of these issues in an adult population. METHODS: A retrospective chart review was conducted for all bladder exstrophy complex patients who underwent surgery at a young age and were subsequently referred to our center between 2005 and 2020. Inclusion criteria included patients with cloacal or classical bladder exstrophy older than 18 years. We recorded the reasons for referral, management of contemporary complaints, types of past and present urinary reconstructions, and their current functional status. RESULTS: The study included 38 patients. The primary reasons for referral were incontinence (39%) and catheterization difficulties (24%). Management typically involved partial or complete surgical revision of their urinary reservoir, occasionally combined with a bladder neck procedure. Ultimately, only three patients continued to experience incontinence, while none reported catheterization issues after undergoing treatment at our center. Long-term exstrophy-related reconstruction complications included urinary tract infections (39%), stones (29%), stenosis (24%), fistulas (13%), chronic renal disease (16%), metabolic abnormalities (3%), and cancer (3%). CONCLUSIONS: Adults who have previously undergone bladder exstrophy reconstruction exhibit a wide range of urologic reconstructions. Their needs often revolve around continence and catheterization concerns. Most patients with satisfactory functional outcomes perform self-catheterization through a continent cutaneous channel and have either a continent pouch or an augmented bladder. [ABSTRACT FROM AUTHOR]

Background: Ileoanal pouch is a demanding procedure with many potential technical complications including bladder or ureteral injury, while inflammation or stricture of the anastomosis or anal transition zone may lead to the formation of strictures and fistulae, including to the adjacent urethra. Pouch urinary tract fistulae are rare. We aimed to describe the presentation, diagnostic workup, and management of patients with pouch urinary at our center. Methods: Our prospectively maintained pouch registry was queried using diagnostic codes and natural language processing free-text searches to identify ileoanal pouch patients diagnosed with any pouch-urinary tract fistula from 1997 to 2022. Descriptive statistics and pouch survival using Kaplan–Meier curves are presented. Numbers represent frequency (proportion) or median (range). Results: Over 25 years, urinary fistulae were observed 27 pouch patients; of these, 16 of the index pouches were performed at our institution [rate 0.3% (16/5236)]. Overall median age was 42 (27–62) years, and 92.3% of the patients were male. Fistula locations included pouch-urethra in 13 patients (48.1%), pouch-bladder in 12 patients (44.4%), and anal-urethra in 2 (7.4%). The median time from pouch to fistula was 7.0 (0.3–38) years. Pouch excision and end ileostomy were performed in 12 patients (bladder fistula, n = 3; urethral fistula, n = 9), while redo ileal pouch-anal anastomosis (IPAA) was performed in 5 patients (bladder fistula, n = 3; urethral fistula, n = 2). The 5-year overall pouch survival after fistula to the bladder was 58.3% vs. 33.3% with urethral fistulae (p = 0.25). Conclusion: Pouch-urinary tract fistulae are a rare, morbid, and difficult to treat complication of ileoanal pouch that requires a multidisciplinary, often staged, surgical approach. In the long term, pouches with bladder fistulae were more likely to be salvaged than pouches with urethral fistulae. [ABSTRACT FROM AUTHOR]

Objectives: Vesicovaginal fistulas (VVF) are the most commonly acquired fistulas of the urinary tract. The management of VVF is mainly based on expert opinion and surgeon experience. This study aims to provide the practice patterns and outcomes of vesicovaginal fistula (VVF) management in Indonesia. Methods: This study utilizes the results of a survey among the surgeons who performs VVF repair in referral hospitals throughout Indonesia between June and July of 2021. Data analysis was carried out with SPSS descriptively by displaying the relative frequency of the answers to each question of the questionnaire form. Results: We collected responses from 93 respondents consisting of 68 urologists and 25 gynecologists. The most commonly reported cause of VVF was obstetric (50.5%). Most respondents confirmed the diagnosis of VVF by cystoscopy (81.7%). Waiting time to repair VVF was generally 12 weeks (79.6%), while the transvaginal approach repair was more often performed (77.4%). An additional procedure, such as tissue interposition was performed in 50.5% of cases. Tissue interposition was mostly indicated in recurrent VVF (81%), with omentum being the most selected tissue interposition (71%). When indicated, the most selected method of transabdominal approach was open transvesical (54,84%). A laparoscopic approach was performed only in 7.5% of cases. Overall, the success rate for VVF repair in Indonesia was 70-100% at first attempt. Conclusions: The transvaginal approach is preferred, either with or without an interposition tissue flap. The success rate at the first attempt is satisfactory. [ABSTRACT FROM AUTHOR]

Simultaneous liver–kidney transplantation is indicated for patients with concomitant end-stage liver disease and end-stage renal disease. The traditional technique involves separate implantations of the liver and the kidney. In the en bloc approach, the liver is recovered en bloc with the right kidney and the donor renal artery is anastomosed to the donor splenic artery. We aimed to compare the outcomes of the traditional and en bloc techniques for simultaneous liver–kidney transplantation in a single center. This single-center retrospective study involved all adult patients who underwent simultaneous liver–kidney transplantation from brain-dead donors from January 2017 to December 2022. A total of 15 patients were included: 10 transplanted with the traditional technique and 5 with the en bloc approach. Patients in the en bloc group presented higher body mass index, shorter kidney cold and total ischemia times, shorter overall surgical time and longer kidney warm ischemia time (29.07 kg/m2vs 23.20 kg/m2 [ P =.048]; 560 minutes vs 880 minutes [ P =.026]; 615 minutes vs 908 minutes [ P = 0.025]; 405 minutes vs 485 minutes [ P =.046]; 46 minutes vs 33.5 minutes [ P = 0.027], respectively). Ureteroneocystostomy was performed in 2 patients of the en bloc group and ureteroureterostomy in the remaining 3 patients. One patient in the en bloc group presented stenosis of renal artery anastomosis and underwent percutaneous angioplasty. This same patient eventually developed late urinary fistula. In the traditional technique group, there were 2 cases of renal vein thrombosis and 1 of ureteral stenosis. Compared with the traditional technique, the en bloc approach is feasible and safe, reducing kidney total ischemia time and overall surgical time. [ABSTRACT FROM AUTHOR]

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.

Urinary-cutaneous fistulas are typically treated by pediatric urologists and typically arise after surgical interventions. The three atypical cases of acquired urethrocutaneous fistula that we present here have variously resulted from an untreated periurethral abscess to complications of an initial urethral calculi. To prevent an intraoperative surprise, learning from our cases put emphasis on the importance of early intervention and a high index of suspicion for underlying calculi. We also cover the pathology, diagnosis, and therapy of these uncommon instances of acquired urethrocutaneous fistula. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to explore the safety and feasibility of single-port nephroscopy combined with a needle electrode technique to unroof single dorsal simple renal cysts (SRCs). Methods: This was a retrospective analysis of the clinical data for 18 patients with single dorsal SRCs treated with single-port nephroscopy and a needle electrode technique at Zhongshan City People's Hospital from August 2021 to August 2022. The basic information included the cyst condition, surgical methods and recurrence rate, and follow-up was conducted with CT imaging. Results: The surgery was successful in all 18 patients. The duration of surgery ranged from 24 to 46 min, with an average of 35.83 ± 1.62 min; the intraoperative bleeding volume ranged from 2 to 20 mL, with an average of 9.0 ± 1.3 mL; and the visual analog scale (VAS) score within 24 h after surgery ranged from 1 to 6 points, with an average of 2.72 ± 0.36 points. There were no significant postoperative complications, such as bleeding, urinary fistula, or infection. All drainage tubes were removed on the first day after surgery. After 1 year of postoperative follow-up, 1 patient experienced recurrence, for a recurrence rate of 5.6%. Conclusion: Single-port nephroscopy combined with a needle electrode technique is a safe, feasible, and effective minimally invasive surgical approach for treating single dorsal SRCs. [ABSTRACT FROM AUTHOR]

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]

Background: In recent years, open nephron sparing partial nephrectomy (OPN) has been gradually applied and generally accepted. Recent statistical data show that PN not only can safely and effectively preserve the functional nephron, but also has fewer complications, low local recurrence rate and no significant difference in long-term survival rate compared with nephrectomy/radical nephrectomy, which has gradually become a routine treatment for small renal cell carcinoma. Therefore, how to maximize the protection of postoperative residual renal function (RRF) and reduce the risk of CKD while achieving the ideal local and overall tumor control effect is the key to the treatment of renal cancer, and is also the focus of attention of urologists and nephrologists. Objective: To evaluate the safety of retroperitoneal laparoscopic partial nephrectomy (RLPN) by investigating the perioperative indicators and postoperative follow-up. Methods: A total of 40 hospitalized patients in our hospital from December 2019 to December 2021 were selected and followed up for a long time. Patients with renal tumors less than 4cm in diameter and exogeneous or partial exogeneity were randomly divided into 2 groups. Patients in retroperitoneal laparoscopic group (n = 20) were treated with nephron sparing partial nephrectomy (0.5-1cm). Twenty patients underwent retroperitoneal laparoscopic radical nephrectomy (LRN). The time of removal of drainage tube, drainage volume, time of feeding activity and postoperative hospital stay were recorded, and the safety of the operation was evaluated. Results: nephron sparing partial nephrectomy is suitable for patients with localized renal carcinoma or benign tumor <4cm. RLPN can be applied to all indications of open nephron sparing partial nephrectomy (OPN), with good safety, and can preserve residual renal function to the greatest extent. The operative vascular occlusion time was controlled within 40 minutes, and the use of renal function protection measures during the operation was safe and controllable in reducing the prevention of warm ischemic kidney damage, with good safety. The renal tumor capsule with 0.5cm~1cm margin was complete by postoperative pathology. In the process of tumor resection and suture collection system in the RLPN group, we improved the previous operation of "resection before hemostasis" to "resection while hemostasis" and "knot-free suture" technology, which saved the operation time of intracavity suture knotting. Reduced cortical tear caused by vertical pull during knot tying. The combined effect of biological clip and hemostatic gauze can stimulate the granulation proliferation of renal cortical wound and accelerate the repair. With the combination of knot-free suture and renal segment vascular occlusion, hot ischemic kidney damage is reduced. In the RLPN group, there were no complications of urinary fistula and bleeding, and no abnormal changes in renal function during follow-up. The safety of RLPN group is worthy of affirmation. Conclusion: The perioperative safety and short-term postoperative renal function recovery of RLPN are good, and the overall safety of this operation is worthy of affirmation. [ABSTRACT FROM AUTHOR]

Transurethral prostate surgery can lead to a rare and late complication known as a prostatosymphyseal fistula. In the literature, there are only a limited number of reported cases of this type of fistula. This case underscores the complexities involved in disease management, as well as the challenges in establishing an initial diagnosis, given the inadequacy of conventional imaging methods to detect prostate-symphyseal fistulas. The presence of non-urological symptoms in patients often impedes the recognition of prostatesymphyseal fistulas, leading to a delay in diagnosis. In this case report, a patient who presented to the emergency department with complaints of sudden-onset difficulty walking and fever in the second month after bipolar transurethral resection of the prostate is presented. The diagnosis of pubic osteomyelitis and prostatosymphyseal fistula was made using advanced examinations such as contrast-enhanced pelvic computed tomography and magnetic resonance imaging. In the treatment, transperitoneal fistula tract excision and repair with an omental flap were performed. No complaints were observed during the 1-year postoperative follow-up. The surgeon's vigilant approach is paramount for promptly identifying this rare complication. [ABSTRACT FROM AUTHOR]

This article from the Arab Journal of Interventional Radiology discusses the use of interventional radiology techniques in cases where conventional surgical procedures are not effective. Specifically, it focuses on the Amplatzer plug and glue "sandwich" technique for ureteric embolization. The case presented involves a 79-year-old male with rectal cancer who experienced a ureter injury during surgery. Despite unsuccessful urological corrective procedures, the patient found relief through ureteric embolization using Amplatzer plugs and cyanoacrylate glue. The article concludes by highlighting the effectiveness of this technique and its potential long-term results. [Extracted from the article]

Endovascular repair has gained acceptance for the treatment of arterio-ureteral fistula (AUF). However, data on associated postoperative complications are relatively scarce. We report the case of a 59-year-old woman with an external iliac artery (EIA)-ureteral fistula treated by endovascular stentgraft placement. Hematuria resolved after the procedure; however, occlusion of the left EIA and migration of the stentgraft into the bladder occurred 3 months postoperatively. Endovascular repair is a safe and effective method for the treatment of AUF, but it needs to be carefully followed. Extravascular migration of a stentgraft is a rare but possible complication. [ABSTRACT FROM AUTHOR]

Copyright of Die Urologie is the property of Springer Nature 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.)

Acquired rectourethral fistula (RUF) is a rare but major complication of posterior urethral valve ablation. We present a case of a 1-year-old boy managed in a staged manner by completion of posterior urethral valves ablation, colostomy, RUF division through anterior sagittal transanorectal approach, and stoma closure. The child is continent for urine and feces. [ABSTRACT FROM AUTHOR]

BackgroundFistulas are an abnormal connection between two or more epithelial surfaces. When fistulization between adjacent structures occurs in the pelvis, there is almost invariably significant associated morbidity and impact on a patient's quality of life. Imaging may aid in the diagnosis of pelvic fistulas and is essential to identify any associated pathology, define the course of the fistula, and aid in pre-surgical planning.PurposeThis article aims to review the wide array of clinical and imaging presentations of fistulas in the pelvis, with a focus on the radiologists' role in managing this challenging entity.MethodsThis article will review each classification type of fistula.ResultsPelvic fistula is a devastating condition that causes significant morbidity and evaluation can be challenging.ConclusionsImaging, and particularly MRI, plays a vital role in the diagnosis, characterizing the course of a fistula and demonstrating associated complications, which are essential to guide treatment decisions.

Background: Phalloplasty in transgender men is performed with or without Urethral Lengthening (UL). To create clear expectations in the choice of UL, an overview and comparison of outcomes is useful. Aims: To provide and compare surgical outcomes and urinary functioning after phalloplasty with versus without UL in transgender men. Methods: A single-center, retrospective chart review was conducted among transgender men who underwent phalloplasty with or without UL between 01-2013 and 10-2020. Primary outcomes were differences in complication and reoperation rates. Secondary outcomes were end-stages of voiding at last follow-up and differences in voiding analyses pre- and postoperatively. Results: Of 136 men, 91 (67%) underwent phalloplasty with, and 45 (33%) without UL. Wound infection (31 vs. 16%, p = 0.06) and partial flap loss (35 vs. 13%, p = 0.008) were predominately seen after UL. In the UL group, 43% urethral fistulas and 60% urethral strictures were observed, relative to one man without UL who had a urethral fistula (both p < 0.001). Meatal or perineal orifice stenosis was seen in 29% with versus 11% without UL (p = 0.02). Reoperation was needed in 81% with versus 27% without UL (p < 0.001). At follow-up, 80/91 (88%) after UL reached end-stage of voiding, with 60/80 (75%) able to void while standing and 20/80 (25%) having a definitive urethrostomy. The remaining 11/91 (12%) men were awaiting further treatment for urological complications. The men able to void while standing had a median of one reoperation (range 0–6), and a significant decrease in maximum flow rate on postoperative uroflowmetry (21.4 vs. 29.8 mL/s, p < 0.001). After phalloplasty without UL, all men had a definitive perineostomy without changes in voiding analyses. Discussion: The choice for or against UL during phalloplasty has become more relevant over the years. This comparison of surgical outcomes and urinary functioning can be useful in the shared decision-making process to come to the most suitable choice of phalloplasty. [ABSTRACT FROM AUTHOR]

To evaluate the healthcare resource impact of radiation injury following prostate cancer treatment. Using IBM MarketScan, we performed a retrospective study of men with prostate cancer who were treated with radiotherapy and subsequently developed low-grade (LGRI) and high-grade radiation injury (HGRI). Radiation injury diagnoses included bladder neck stenosis, hematuria/cystitis, fistula, ureteral stricture, and incontinence. LGRI and HGRI included injury diagnosis without intervention and with intervention, respectively. Health care visits and costs were measured over 5 time periods including 2 years before radiation, 1 year before radiation, radiation to injury diagnosis, injury diagnosis to first intervention (LGRI), and following first intervention (HGRI). Negative binomial regression modeling was used to assess the effect of radiation injury on average cost adjusting for demographics and comorbidities. Between 2008 and 2017, we identified 121,027 men who received radiotherapy following prostate cancer diagnosis of which 10,057 (8.3%) experienced a HGRI. The frequency of urologic visits and average costs were similar in those without injury and LGRI. However, men with HGRI experienced higher visit frequency and monthly costs. Amongst high-grade injuries, urinary fistula had the highest frequency of visit utilization at 378 visits before first intervention and 245 visits after first intervention. Following radiation injury diagnosis, the average monthly cost was twice as high in those with HGRI ($85.78) compared to LGRI ($38.66). HGRI was associated with increased urologic health care use and average monthly cost when compared to those who experienced LGRI or no injury. Urinary fistula was associated with the largest resource burden. [ABSTRACT FROM AUTHOR]

Introduction: Despite the advancements in technique and technology, urethrocutaneous fistula (UCF) formation continues to be the most common complication after hypospadias repair. Objective: The objective of the current synthesis is to define the indications of PATIO technique for UCF repair. Materials and Methods: The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, Ovid, Embase, Web of Science, and Google Scholar were interrogated for studies presenting primary data upon UCF repair by the PATIO technique. Data analysis was performed on MedCalc and R software. Results: Eighteen studies were identified relevant to the current context: inversion of UCF tract has been described in 13 and ligation in 5. There were 2 duplications (abstract and manuscript). The overall success for PATIO is 88.2% (314/356). The success rate was variable between classic PATIO (inversion at 87.2%), ligation-inversion at 86.9%, and ligation alone at 88.9%. The success rate was not improvised upon by supplementing inversion of UCF tract with ligation (p = 0.957) or addition of a waterproofing layer (p = 0.622). PATIO has been used for single or multiple UCFs post hypospadias repair, genital piercing, and genitoplasty in cis- or transgender population for UCF up to 5 mm in size. The success rates were best for UCF <2 mm and worst for those approaching 5 mm. The results were, however, unaffected by the location of UCF along the penile shaft. Besides, the use of urethral catheter is optional and may be eliminated with shorter hospitalization. Conclusions: PATIO repair may be considered for repair of UCFs (a) with diverse etiologies, (b) located anywhere along the penile shaft included coronal UCF, (c) preferably <4 mm in size, (d) single or multiple in number; multiple PATIOs may be done in the same setting, (e) in patients unwilling for prolonged hospitalization, (f) in patients unwilling for a urethral catheter, and (g) in hypospadias cripples wherein mobilization of distant tissues such as tunica vaginalis flap or a buccal mucosal graft may be required for supplementing the UCF repair. [ABSTRACT FROM AUTHOR]

Despite advances in surgical techniques and multimodality therapy for anal canal and rectal cancers, local recurrence and unresectable disease remain a significant challenge, often associated with poor quality of life. It is not clear how best to address this entity in the absence of large prospective randomized trials. The aim of this study was to retrospectively evaluate the outcomes and toxicities of pelvic low dose rate brachytherapy (LDR) combined with surgical resection in patients with unresectable and locally recurrent anorectal cancers. Following IRB approval, patients with biopsy-proven anorectal cancers who underwent LDR during surgery for unresectable or locally recurrent anorectal cancers from 2004 to 2022 were included. Patients who had LDR for recurrent gynecological or genitourinary cancers were excluded. For all patients, the intent of surgery was complete resection of all visible disease. This was followed by LDR, either in the surgical bed for recurrent cancers or the site of microscopically positive margins for the unresectable patients. Following LDR mesh fixation with sutures, an omental flap was draped over the site of LDR to prevent seed migration and to minimize dose to organs at risk. Toxicity grading was done using the Common Terminology Criteria for Adverse Events (CTCAE) Version 5. Out of 29 eligible patients, 20 underwent Iodine-125 LDR, and 9 received Cesium-131 LDR with an average of 73.8 sources used per patient. The primary site was colorectal in 79.3% and anal canal in 20.7%. 27 (93.1%) of the patients had pelvic only disease at the time of LDR and surgery. 21 (72.4%) patients had at least 1 surgery prior to the implant prior to the implant, whereas 8 (27.6%) patients had no surgery prior to the implant. Brachytherapy was offered at recurrence in 23 patients (79.3%) and in 6 (20.7%) patients who were considered unresectable initially. In those with recurrences, 20 (87.0%) had LDR offered during their first recurrence and the rest were offered LDR at subsequent recurrences. Chemotherapy was offered at first recurrence in 21 (91.3%) patients. No Grade 4 or 5 toxicities were reported. The most common adverse event seen was neuralgia in 12 (41.4%) patients with 2 of those developing Grade 3 neuralgia. The rate of Grade 2 gastrointestinal fistula was 5 (17.2%) and Grade 2 urinary fistula was 3 (10.3%). All of the patients who developed fistulas were diverted at the time of surgery and LDR or before, and did not require additional invasive interventions. The 12 month and 24 month local progression free survival were 55.4% (95% CI: 34.9-71.8) and 41.7% (95% CI: 22.3 - 60.1), respectively. The 12 month and 24 month progression free survival were 38.4% (95% CI: 20.7-55.9) and 25.6% (95% CI: 10.9-43.3), respectively. The 12 month and 24 month overall survival rates were 88.7% (95% CI: 69.0-96.2) and 70.6% (95% CI: 47.7-84.9), respectively. LDR in combination with resection of all macroscopic disease in unresectable or locally recurrent anorectal cancers is a viable treatment option. Toxicities are acceptable, with no Grade 4 or 5 adverse events in this cohort. Fistulas were managed expectantly as the patients who developed fistulas were already diverted. Furthermore, it is not clear if the fistulas developed as an adverse event of LDR or were due to local tumor progression. Progression free survival and overall survival at 12 and 24 months align with prior retrospective reports. Our study is subject to the limitations of being a retrospective study with a small sample size. However, the findings are encouraging and warrant further prospective studies to guide the management of these heterogenous and often challenging cases. [ABSTRACT FROM AUTHOR]

The editorial discusses the ongoing challenges faced by women who experience obstetric fistulas, resulting in urinary leakage post-repair. It emphasizes the need for patient education, research, and innovation to achieve evidence-based management of this condition. The editorial highlights the complexity of the disorder, the potential for ongoing urinary leakage even after successful repair, and the lack of long-term evidence supporting current surgical treatments for post-fistula repair urinary incontinence. The authors call for collaborative efforts among urogynecological and fistula societies to improve patient care and outcomes through transparent research and innovation. [Extracted from the article]

Kidney donors with asymptomatic small kidney stones were increasingly accepted in kidney transplantation (KT) due to organ shortage and advances in endoscopic urology. However, recipients' clinical outcomes using these donors remained unclear. We conducted a meta-analysis to summarize transplant outcomes using these donors with asymptomatic small kidney stones. Finally, 15 retrospective studies were included. The prevalence of asymptomatic small kidney stones was 5.3% (95%CI 3.5–7.8%). After transplantation, low incidence of urinary fistula (0%, 95%CI 0–1.0%), obstruction (0%, 95%CI 0–1.1%), relapse of kidney graft stone (0.3%, 95%CI 0–2.5%), and delayed graft function (0.6%, 95%CI 0–3.5%) was reported. Pooled serum creatinine was 1.3 (95%CI 1.2–1.5) mg/dl and 1.4 (95%CI 1.2–1.6) mg/dl at post-transplant 1 month and 1 year, respectively. Notably, we observed numerically higher relapse rate after conservative management (1.8% [0–9.2%] vs 0% [0–1.8%]) but numerically higher DGF rate after surgical removal of asymptomatic stones (1.8% [0–7.0%] vs 0% [0–1.9%]). Overall, short-term transplant outcomes using kidneys with asymptomatic small stones were acceptable. However, long-term transplant outcomes remained unexplored. Well-designed prospective studies are also needed to compare the efficacy of conservative management with surgical removal of "donors' gifted" asymptomatic kidney stones. [ABSTRACT FROM AUTHOR]

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Kidney cancer is a common urologic malignancy with either laparoscopic (LPN) or robotic partial nephrectomy as therapeutic options of choice for localized tumors. However, renal resection and suturing are challenging steps of the procedure that can lead to complications such as prolonged warm ischemia, bleeding, and urinary fistulas. LPN with a diode laser is an efficient technique due to its cutting and/or coagulation attributes. Surprisingly, key laser features such as wavelength and power remain undefined. Using a large porcine model, we evaluated the laser range of wavelength and power in a clamp-free LPN and compared it to the established gold-standard LPN technique (i.e., cold-cutting and suturing). By analyzing surgery duration, bleeding, presence of urine leak, tissue damage related to the resected renal fragment and the remaining organ, hemoglobin levels, and renal function, we show that an optimized experimental diode laser clamp-free LPN (wavelength, 980 nm; power, 15 W) had shorter surgery time with less bleeding, and better postoperative renal function recovery when compared to the well-established technique. Together, our data indicate that partial nephrectomy with a diode laser clamp-free LPN technique is an improved alternative to the gold-standard technique. Therefore, translational clinical trials towards human patient applications are readily feasible. [ABSTRACT FROM AUTHOR]

A urethrorectal fistula is a rare congenital or acquired condition in dogs. Its treatment has been reported through a perineal incision, but not through a rectal mucosal approach. A 10‐month‐old, entire, male French bulldog was presented with leakage of urine from the rectum and urethra during urination, which was diagnosed as urethrorectal fistula by computed tomography, and surgery was performed. In our case, a rectal mucosal approach was used instead of a perineal approach, which has been reported previously. Postoperatively, the fistula tract was completely blocked and treatment was successful. Most treatment of urethrorectal fistulas involves excision of the fistula tube or urinary diversion, but the surgical approach should be considered depending on the location of the fistula. Because the perineum contains more important nerves and muscles related to defecation than the rectal mucosa, the rectal mucosal approach minimizes damage to muscles and nerves and reduces complications. [ABSTRACT FROM AUTHOR]

Background: In recent years, open nephron sparing partial nephrectomy (OPN) has been gradually applied and generally accepted. Recent statistical data show that PN not only can safely and effectively preserve the functional nephron, but also has fewer complications, low local recurrence rate and no significant difference in long-term survival rate compared with nephrectomy/radical nephrectomy, which has gradually become a routine treatment for small renal cell carcinoma. Therefore, how to maximize the protection of postoperative residual renal function (RRF) and reduce the risk of CKD while achieving the ideal local and overall tumor control effect is the key to the treatment of renal cancer, and is also the focus of attention of urologists and nephrologists. Objective: To evaluate the safety of retroperitoneal laparoscopic partial nephrectomy (RLPN) by investigating the perioperative indicators and postoperative follow-up. Methods: A total of 40 hospitalized patients in our hospital from December 2019 to December 2021 were selected and followed up for a long time. Patients with renal tumors less than 4cm in diameter and exogeneous or partial exogeneity were randomly divided into 2 groups. Patients in retroperitoneal laparoscopic group (n = 20) were treated with nephron sparing partial nephrectomy (0.5-1cm). Twenty patients underwent retroperitoneal laparoscopic radical nephrectomy (LRN). The time of removal of drainage tube, drainage volume, time of feeding activity and postoperative hospital stay were recorded, and the safety of the operation was evaluated. Results: nephron sparing partial nephrectomy is suitable for patients with localized renal carcinoma or benign tumor <4cm. RLPN can be applied to all indications of open nephron sparing partial nephrectomy (OPN), with good safety, and can preserve residual renal function to the greatest extent. The operative vascular occlusion time was controlled within 40 minutes, and the use of renal function protection measures during the operation was safe and controllable in reducing the prevention of warm ischemic kidney damage, with good safety. The renal tumor capsule with 0.5cm~1cm margin was complete by postoperative pathology. In the process of tumor resection and suture collection system in the RLPN group, we improved the previous operation of "resection before hemostasis" to "resection while hemostasis" and "knot-free suture" technology, which saved the operation time of intracavity suture knotting. Reduced cortical tear caused by vertical pull during knot tying. The combined effect of biological clip and hemostatic gauze can stimulate the granulation proliferation of renal cortical wound and accelerate the repair. With the combination of knot-free suture and renal segment vascular occlusion, hot ischemic kidney damage is reduced. In the RLPN group, there were no complications of urinary fistula and bleeding, and no abnormal changes in renal function during follow-up. The safety of RLPN group is worthy of affirmation. Conclusion: The perioperative safety and short-term postoperative renal function recovery of RLPN are good, and the overall safety of this operation is worthy of affirmation. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the use of tubularized incised plate (TIP) urethroplasty for distal second- and third-degree hypospadias to free the dysplastic forked corpus spongiosum and Buck's fascia, which are used as a covering material for the new urethra, thereby reducing the incidence of urinary fistula and other complications in the coronal sulcus. Materials and Methods: Clinical data of 113 patients with distal hypospadias treated with TIP urethroplasty from January 2017 to December 2020 were retrospectively analyzed. The study group comprised 58 patients (use of dysplastic corpus spongiosum and Buck's fascia to cover the new urethra), and the control group comprised 55 patients (use of dorsal Dartos fascia to cover the new urethra). Results: All children were followed up for more than 12 months. In the study group, 4 patients developed urinary fistulas, 4 developed a urethral stricture, and no case developed glans fissure. In the control group, 11 patients developed urinary fistulas, 2 developed a urethral stricture, 3 developed a glans cracking. Conclusion: Using the dysplastic corpus spongiosum to cover the new urethra increases the amount of tissue in the coronal sulcus and reduces the incidence of urethral fistula, but it may increase the incidence of urethral stricture. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to measure the frequency of complications associated with uretero-ureteral anastomosis (UUA) in patients with a history of renal transplantation. Methods: An analytical cross-sectional study was carried out in which clinical records of patients with a history of renal transplantation were reviewed. Patients treated with UUA after a urological complication was selected. All of the above, with the permission of the institutional authorities and the Ethics Committee. For the statistical analysis, measures of central tendency, frequencies, and proportions were used. Results: A total of 24 patient files were identified that met the inclusion criteria. A total of 16.6% (n = 4) of the patients presented complications after UUA. The most frequent complication was urinary leakage. Variables such as sex and chronic degenerative diseases were included in the study. There was no significant difference between groups using these variables. Only serum creatinine presented values of p < 0.01. Conclusion: The present study shows that UUA is a safe procedure that offers a considerable decrease in the incidence of complications when compared to other less invasive strategies such as JJ catheter placement or nephrostomy. In general terms, it improves the quality of life and the functional time of the graft in the face of an early complication. [ABSTRACT FROM AUTHOR]

A 33-year-old male patient with a 17-year Behcet's syndrome history showed abdominal pain and fever symptoms. The abdominal CT was suggestive of an acute ileocecal intestinal perforation. In addition, the symptoms disappeared after the conservative treatment. Some related examinations, including capsule endoscopy, were performed to explain the phenomenon of the food residue urine. These results indicated the intestine-urinary tract fistula formation, supposed to be the outcome of intestinal Behcet's syndrome perforation. This is a rare case of intestinal Behcet's syndrome with abdominal symptoms as the main manifestation. It was complicated by entero-urinary fistula formation and urinary tract infections. Now, we report this story to emphasize that capsule endoscopy is conducive to the diagnosis and assessment of the intestinal Behcet's syndrome; moreover, anti-inflammatory treatment including biological agents is effective to relieve the disease at the acute stage in addition to surgical methods. [ABSTRACT FROM AUTHOR]

The article offers clinical studies related to minimally invasive surgery procedures in urogynecology. Topics include information on laparoscopic sacrocolpopexy (LSC), a standard procedure of laparoscopic mesh surgery which is expected to increase as a treatment for pelvic organ prolapse (POP) due to entering an aged society; and Robotic-assisted sacrocolpopexy (RSC) is considered convenient and is expected to have a certain impact on minimally invasive POP surgery.

Objective: This study aimed to identify the risk factors for genitourinary fistulas and delayed fistula recognition after radical hysterectomy for cervical cancer. Methods: This study was a retrospective analysis of data collected in the Major Surgical complications of Cervical Cancer in China (MSCCCC) database from 2004-2016. Data on sociodemographic characteristics, clinical characteristics, and hospital characteristics were extracted. Differences in the odds of genitourinary fistula development were investigated with multivariate logistic regression analyses, and differences in the time to recognition of genitourinary fistula were assessed by Kruskal-Wallis test. Results: In this study, 23,404 patients met the inclusion criteria. Surgery in a cancer center, a women's and children's hospital, a facility in a first-tier city, or southwest region, stage IIA, type C1 hysterectomy, laparoscopic surgery and ureteral injury were associated with a higher risk of ureterovaginal fistula (UVF) (p<0.050). Surgery in southwest region, bladder injury and laparoscopic surgery were associated with greater odds of vesicovaginal fistula (VVF) (p<0.050). Surgery at cancer centers and high-volume hospitals was associated with an increase in the median time to UVF recognition (p=0.016; p=0.005). International Federation of Gynecology and Obstetrics (FIGO) stage IIA1-IIB was associated with delayed recognition of VVF (p=0.040). Conclusion: Intraoperative urinary tract injury and surgical approach were associated with differences in the development of UVFs and VVFs. Patients who underwent surgery in cancer centers and high-volume hospitals were more likely to experience delayed recognition of UVF. Patients with FIGO stage IIA1-IIB disease were more likely to experience delayed recognition of VVF. [ABSTRACT FROM AUTHOR]

• Double-barrelled wet colostomy presents advantages like the single stoma placement and the simplicity of the technique. • There are no differences in the rate of complications between double-barrelled wet colostomy and Bricker ileal conduit. • The long-term complications related to urinary diversion remain high despite the type of technique. • The DFS and OS after 48 months of follow up was 51 % and 58 % respectively. After exhausting other therapeutic options, pelvic exenteration is performed in patients who suffer from relapsed gynaecologic tumours, with most of them requiring some sort of urinary diversion. The main objective of this study was to assess the short- and medium/long-term urinary complications associated with the Bricker ileal conduit versus double-barrelled wet colostomy after performing a pelvic exenteration for gynaecologic malignancies. A total of 61 pelvic exenterations were identified between November 2010 and April 2022; 29 Bricker ileal conduits and 20 double-barrelled wet colostomies were included in the urinary diversion analysis. Regarding the specific short-term urinary complications, no differences were found in the rate of urinary leakage (3 vs 0 %; p = 1), urostomy complications (7 vs 0 %; p = 0.51), acute renal failure (10 vs 20 %; p = 0.24) or urinary infection (0 vs 5 %; p = 0.41). Up to 69 % of patients with Bricker ileal conduits and 65 % of double-barrelled wet colostomies (p = 0.76) presented specific medium/long-term urinary complications. No differences in the rates of pyelonephritis (59 vs 53 %; p = 0.71), urinary fistula (0 vs 12 %; p = 0.13), ureteral stricture (10 vs 6 %; p = 1), conduit failure and reconstruction (7 vs 0 %; p = 0.53), renal failure (38 vs 29 %; p = 0.56) or electrolyte disorders (24 vs 18 %; p = 0.72) were found. There are no significant differences in the rate of complications between double-barrelled wet colostomy and the Bricker ileal conduit. The long-term complications related to urinary diversion remained high regardless of the type of technique. In this context, the double-barrelled wet colostomy presents advantages such as the single stoma placement and the simplicity of the technique. [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]

Introduction and hypothesis: The association between hysterectomy type, laparoscopy use and vesicovaginal fistula (VVF) is currently unclear and would be useful to determine route of surgery and provide adequate patient counseling. The objective of this study was to evaluate the magnitude of association between the use of laparoscopic assistance, recognized intraoperative urinary tract injury and subsequent VVF repair and to quantify any differences in fistula repair and injury detection by hysterectomy type. Lastly, we sought to determine whether the type of hysterectomy is a risk factor for VVF repair independent of injury identification. Methods: We performed a retrospective cohort study utilizing the Healthcare Cost and Utilization Project database examining benign hysterectomies performed in California, New York and Florida from 2005–2011. Multivariable logistic regression models were used to evaluate associations among hysterectomy type, reported injury and VVF. Results: Of 581,395 eligible hysterectomies, urinary tract injuries occurred in 6702 patients (1.15%) and 640 patients developed VVF (0.11%). Patients with reported injury were 20-fold more likely to develop VVF than those without (OR = 20.6; 1.96% vs. 0.089% respectively). The association between reported injury and VVF development was stronger if laparoscopy was involved (OR = 30) than if it was not (OR = 17). Patients undergoing laparoscopic procedures were less likely to have injury reported (OR = 0.6) but more likely to undergo VVF repair (OR = 1.5). This association with VVF repair was independent of injury identification. Patients developing VVF were more likely to have undergone total abdominal hysterectomy compared to other hysterectomy types. Conclusions: Laparoscopy is an independent risk factor for the need for subsequent VVF repair, independent of hysterectomy type and presence of intraoperatively recognized urinary tract injury. [ABSTRACT FROM AUTHOR]

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 conducted. 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 diagnostic sensitivity (50%) and endovascular treatment with stentgraft placement across the fistula is the current state of the art treatment choice. Conclusions: Failure to diagnose can postpone a potentially lifesaving targeted therapy and lead to complications. The identification of the Trifecta hematuria, history of pelvic surgery (HPS) and history of pelvic radiotherapy (HPR) would allow the identification 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. [ABSTRACT FROM AUTHOR]

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 < 0.05. Urinary fistula was detected in 33 of 96 patients. Univariate analyses showed significant differences in patient age, cyst size, location, hydaturia, eosinophil count, and platelet count between patients with and without urinary fistula. In multivariate analyses, hydaturia (p < 0.005), eosinophil count >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. [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]

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.

ObjectiveTo describe long-term quality of life (QOL) outcomes after rectourethral fistula (RUF) repair. RUF is a debilitating diagnosis and complex surgical dilemma with limited data regarding QOL after repair.MethodsPatients at a tertiary referral center undergoing transperineal RUF repair 1/2009-5/2016 were analyzed. Patients were contacted by telephone to assess QOL following repair. Descriptive analysis performed of short-term surgical data (success and complications) and long-term QOL data (novel questionnaire).ResultsTwenty one men underwent RUF surgery with 95% success after initial repair. Fifty two percent had a history of radiation and/or ablation. Four individuals (19%) experienced a Clavien-Dindo complication within 30 days, with 3 of those being grade III+. Fifteen had postoperative urinary incontinence, of whom 73% underwent artificial urinary sphincter placement. Three previously radiated individuals underwent subsequent urethral stricture surgery. At long-term follow-up (mean 45.6 ± 27.1 months), 53% reported perineal pain, 43% reported problems related to the gracilis flap, and 80% reported urinary incontinence (primarily occasional mild leakage). Twenty one percent were unable to do the things they wanted in their daily lives, while 80% reported that surgery positively impacted their life. None would have opted for complete urinary diversion.ConclusionRUF repair leads to patient satisfaction and improved QOL, despite possible residual issues such as perineal pain and urinary incontinence. Definitive RUF repair should be offered to suitable radiated and nonradiated patients.

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.