Urinary Fistula Research Articles

Medical cases involving foreign bodies can present unique challenges, especially when they occur in sensitive areas, such as the neovagina of a male-to-female transgender. A 32-year-old transgender woman attended a tertiary, academic-affiliated hospital and reported to insert a vaginal dilator into the neovagina after removing its base and after mild abdominal pain and difficulty in removing the dilator after multiple successful attempts, she looked for help in the emergency room. A video article demonstrates a step-by-step approach to remove the device. Under intravenous anesthesia, a neovaginoscopy was performed using a saline solution for dilation with a Bettocchi Hysteroscopy Set, equipped with a 4mm and 30º scope, ultimately revealing the absence of fistulas or perforations. Hydrodistension probably played a major role to reduce difficulty to remove the dilator, as this was clamped with Pozzi forceps after 800ml of infusion. Urogenital fistulas or rupture of the neovaginal vault was excluded after careful revision. Patient was discharged on the same day with a prescription for antibiotics. Neovaginoscopy with an important hydrodistention proved to be a method for locating and removing the entrapped dilator.

Management of urinary fistula after partial nephrectomy using a Pleur-evac drainage system with ureteral catheter.

BackgroundProstate cancer (PCa) precise surgical resection remains a critical challenge due to positive margins compromising outcomes. This study sought to explore the safety and efficacy of DGPR1008, a novel near-infrared (NIR) prostate-specific membrane antigen (PSMA)-targeted fluorescent contrast agent, in fluorescence-guided surgery (FGS) of PCa.MethodsThis single-center, open-label, prospective, single-arm, exploratory study was carried out in The Fourth Affiliated Hospital of Soochow University, China. Patients newly diagnosed with PCa (a Gleason score ≥7) were eligible for enrollment. All patients underwent laparoscopic radical prostatectomy (LRP) with pelvic lymph node dissection (PLND) using DGPR1008. Four dose cohorts were studied: dose cohort A, which received 0.06 mg/kg of DGPR1008 24 h preoperatively; dose cohort B, which received 0.03 mg/kg of DGPR1008 24 h preoperatively; dose cohort C, which received 0.03 mg/kg of DGPR1008 12 h preoperatively, and dose cohort D, which received 0.045 mg/kg of DGPR1008 24 h preoperatively. Safety and efficacy were assessed.ResultsFrom July, 2023 to January, 2024, 14 eligible patients were included in the study. In total, 32 adverse events (AEs) were observed. One patient (7.1%) presented with four serious adverse events (SAEs), including urinary fistula, infected lymphocele, wound complications, and acute exacerbation of chronic obstructive pulmonary disease. None of the AEs or SAEs was found to be associated with the administration of DGPR1008. Compared with the other dose cohorts, DGPR1008 showed the highest sensitivity (80.6%) for detecting PCa in vivo in dose cohort B. Further, dose cohort B provided the highest target-to-background ratio (TBR) through all phases of tumor imaging, both in vivo and ex vivo, on the gross and fixed tissue. DGPR1008 enabled the real-time visualization of tumor-positive surgical margins, and had a sensitivity of 90% in vivo and 100% ex vivo.ConclusionsDGPR1008 is safe and well tolerated, and may be used in the intraoperative identification of primary PCa and positive surgical margins. Dose cohort B (0.03 mg/kg, 24 h preoperatively) is optimal for efficacy and TBR.

Background The purpose of this study was to illustrate the technique of our full retroperitoneoscopic radical nephroureterectomy (frRNU) involving an intracorporeal, extravesical bladder cuff excision (BCE) and assess its safety and early oncological outcomes. Methods Between June 2020 and November 2023, 27 patients underwent frRNU for upper tract urothelial carcinoma. Surgical and oncological outcomes were assessed. Results Two (7%) patients were converted to open distal ureterectomy due to extensive fibrosis of the iliac ureter. Lymph node dissection (LND) was performed in 85% of procedures. Median operative time and blood losses were 230 (IQR: 188, 255) minutes and 125 (IQR: 100, 150) mL, respectively. Complication rate was 33%, with only two (7%) Clavien Dindo ≥ 3 complications and two (7%) patients experienced urinary fistula. Catheter was removed after six (IQR: 5, 7) days. All patients had negative surgical margins and three (11%) were pN+, with 6.5 (IQR: 3, 14) nodes removed. At a median follow-up of 11 (IQR: 3, 25) months, four (15%) patients had bladder recurrence, while no retroperitoneal recurrence occurred. Conclusions Our frRNU is feasible and safe, allowing for appropriate BCE and LND. Surgical outcomes are optimal, complication rate acceptable and short-term oncological outcomes promising.

Summary: Surgical treatment of women suffering from rectocele of 2–3 degrees is a pressing issue. Such patients suffer from severe defecation disorders and are concentrated in proctology departments. For rectocele correction, local tissue plastic surgery is most often used, which involves removing excess vaginal mucosa and suturing portions of the levator muscles. The disadvantage of this method is the high relapse rate. The use of mesh implants significantly reduces the relapse rate, but their installation is associated with the risk of infection, contact erosions of the vaginal mucosa progression and the formation of fistulas that can disable patients.Aims: The method for plastic surgery of the rectovaginal septum developing with a mesh implant protected from contact with the vaginal mucosa and evaluation of its applicability in patients with lower rectocele of 2–3 degrees.Materials and methods: In the Proctology Department of the State Autonomous Healthcare Institution of the Sverdlovsk Region “Regional Clinical Hospital No. 1”, 78 patients with grade 2–3 lower rectocele were treated. The first group consisted of 38 patients who underwent standard technology of rectovaginal septum plastic surgery with local tissues. The second group consisted of 40 women who were treated using a modified technique. The clinical picture before and after surgery, the duration of the intervention, the frequency and severity of postoperative complications, and the dynamics of clinical manifestations after 3 months were assessed.Results: Women in both groups suffered from severe defecation disorders requiring manual assistance. The duration of the operation in the first group was 60 [49; 68] minutes and in the second – 65 [50; 70] minutes (p = 0.226). The patients of the first group had 9 complications of the postoperative period of class II and IIIb according to the Clavien-Dindo classification, the women of the second group had 3 complications related to class II and IIIa, while the average severity of complications was lighter than in the first. The decrease in the severity of complications in patients of the second group is probably due to the unloading of the stitched levators by the implant, preventing the cutting of the sutures applied to them, the formation of seromas and hematomas. On examination after 3 months, 92.2% of women of the first group did not have an anatomical defect in the rectovaginal septum, and 3 patients had a relapse of the disease. 97.4% of women showed an improvement in defecation and only one patient was forced to return to manual assistance. At the same time, after 3 months, 95% of patients of the second group did not have a rectocele. All women of the second group defecate without the use of manual assistance.Conclusions: The modified alloplasty method is applicable and effective in 95% of patients with lower rectocele, is easily tolerated and contributes to a more comfortable course of the early postoperative period. Sutured levators in front of the mesh implant protect it from contact with the vaginal mucosa, which reduces the risk of bedsores and vaginal fistulas.

Morbidity and mortality of salvage radical prostatectomy for prostate cancer: An analysis of the National surgical quality improvement program targeted prostatectomy database.

Pouch advancement flaps for the surgical management of complex pouch-related fistulas: Is there a difference between pouch perineal and pouch vaginal fistulae?

To retrospectively evaluate the clinical efficacy and safety of total 3D laparoscopic ileal ureters replacement for bilateral ureters combined with bladder augmentation in patients with post-radiotherapy long-segment bilateral ureteral strictures and contracted bladder. Clinical data of two patients (aged 72 and 54 years) with radiation-induced long-segment bilateral ureteral strictures and reduced bladder capacity, treated at the Sixth Affiliated Hospital of Jinan University from October 2023 to June 2024, were analyzed. Both presented with bilateral flank pain, recurrent chills/fever, urinary frequency, and urgency. Preoperative ureteral stricture lengths were measured as follows: left 10.4 cm and right 8.7 cm in the first case; left 10.6 cm and right 11.7 cm in the second case. Bladder capacity assessed by nephrostomy-assisted antegrade urography was 90 mL and 130 mL respectively. Both underwent single-position, one-stage totally 3D laparoscopic bilateral ileal ureteral replacement and bladder augmentation based on membrane anatomy principles, with regular postoperative follow-up. Procedures were completed by the same experienced urologist. Operative times were 420 min and 355 min, with intraoperative blood loss of 50 mL (no transfusion required). Postoperative bowel function resumed at the end of 4.5 and 3 days. No major perioperative complications occurred. Ureteral stents were removed at 2 months postoperatively, with imaging showing improved hydronephrosis, unobstructed ureteral drainage, symmetrical bladder morphology, and smooth walls. Postoperative bladder capacities were 230 mL and 250 mL. Follow-up durations were 10 and 8 months. Both patients experienced significant relief of flank pain and lower urinary tract symptoms. No complications (enteric fistula, urinary fistula, or metabolic acidosis) were observed. At the final follow-up, one patient had mildly elevated serum creatinine, while the other showed reduced levels compared with preoperative values; both remained stable. Membrane anatomy-based dissection facilitates safe mobilization of fibrotic ureters with minimal bleeding and collateral damage. Total intracorporeal 3D laparoscopic ileal ureters replacement for bilateral ureters combined with bladder augmentation effectively addresses long-segment ureteral obstruction and improves bladder capacity. This approach is technically safe and feasible, though further validation with larger clinical cohorts is warranted.

Standard chemotherapy suppresses angiogenesis and reduces vascularization of cervical cancer (CC). A more pronounced response to treatment was detected in more vascularized and oxygenated tumors, but it follows that suppression of angiogenesis during initial courses of chemotherapy may lead to a decrease in the response after subsequent treatment. Preservation of the numerical vessel density during therapy can serve as a prognostic factor for an insufficiently good response to treatment. Methods of molecular targeted therapy of CC are aimed primarily at inhibiting angiogenesis and restoring the normal functioning of the immune system fighting the tumor. The addition of targeted antiangiogenic therapy drugs to standard cytostaticagents for the treatment of patients with persistent, recurrent, or metastatic CC increases progression-free survival and overall life expectancy, but the side effects of such therapy are often severe and sometimes fatal. The main complications recorded are neutropenia, central and peripheral arterial and venous thrombosis, the formation of intestinal and vaginal fistulas. Resistance to targeted drugs develops very quickly, followed by restoration and even an increase in vascularization due to the progression of tumor cell hypoxia and the inclusion of angiogenesis pathways without the VEGF participation. It should be noted that suppression of angiogenesis during any method of treating cervical cancer increases hypoxia of the remaining tumor, which contributes to increased production and release of proangiogenic cytokines, such as VEGF, and the progression of angiogenesis.

AimsThe primary aim was to develop a patient‐centred core outcome set (COS) for interventional studies in patients with pouch anal and vaginal fistula (PAVF).MethodPAVFCOS was developed using the methodology outlined by the Core Outcome Measures in Effectiveness Trials (COMET). Systematic review and qualitative patient interviews produced a long list of candidate outcomes. An online Delphi exercise was conducted with stakeholders to prioritise and shortlist outcomes. A consensus meeting of patients and clinicians ratified the final core outcome set.ResultsA systematic review of the literature and 14 qualitative patient interviews produced a long list of 99 outcomes. These were reduced to 46 outcomes and subjected to two rounds of a Delphi exercise with 70 participants, including patients (45%), colorectal surgeons (31%), radiologists (6%), gastroenterologists (11%) and pouch specialist nurses (7%). Thirty‐six outcomes were discussed in a consensus meeting of seven clinicians and seven patients. Seven core outcomes were selected for inclusion: global assessment of continence, pain related to fistula and surrounding area, impact on quality of life of fistula discharge, fistula healing (clinical and radiological), new fistula or abscess, need for rescue intervention (minor or major) and global quality‐of‐life assessment.ConclusionPAVFCOS is the first to establish outcomes that are important to patients with pouch anal and vaginal fistula. PAVFCOS should be used in interventional studies to introduce much‐needed standardisation of outcome reporting in this challenging condition.

Introduction: Urogenital fistulas represent a debilitating condition that compromises urinary and reproductive function, with profound psychosocial impacts. Surgical repair remains the mainstay of treatment, with flap-based reconstruction offering anatomic and functional restoration. Both local and free flap techniques are employed depending on fistula complexity, tissue availability, and previous surgical history. Objective: To evaluate current evidence on the surgical repair of urogenital fistulas using local and free flap techniques, highlighting indications, techniques, outcomes, and complication rates. Methods: A narrative literature review was conducted using PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar. Studies published between 2019 and 2025 were included if they reported on surgical flap-based approaches to vesicovaginal, rectovaginal, or urethrovaginal fistulas. Results and Discussion: Local flaps such as Martius, gracilis, and labial advancement flaps are commonly used for low-complexity cases, while free flaps are reserved for extensive or recurrent fistulas. Flap selection impacts surgical success, tissue viability, and continence restoration. Outcomes are enhanced with multidisciplinary preoperative planning and careful patient selection. Conclusion: Flap-based reconstruction of urogenital fistulas remains a cornerstone in complex pelvic reconstructive surgery. Surgeons should be well-versed in a range of flap techniques to tailor interventions to individual anatomical and clinical contexts.

Objective: To evaluate the feasibility and safety of a fascial space priority approach to total pelvic exenteration (TPE) in patients with pelvic malignancy. Methods: This was a descriptive case series. Relevant clinical data of patients who had undergone TPE via a fascial space priority approach at Tianjin Union Medical Center from September 2017 to March 2025 were retrospectively collected. All operations had been performed via a fascial space priority approach, the guiding principle of which is separating the avascular pelvic spaces first and then transecting the vessels and nerves of the pelvic organs. That is, the avascular planes around all the pelvic organs are dissected first, after which the relevant vessels and nerves are fully dissected and transected, followed by en bloc resection of pelvic organs distally or via perineal approach. The variables studied included relevant surgical parameters, postoperative pathological findings, complications (classified according to the Clavien-Dindo criteria); recurrence-free survival (RFS), overall survival, and tumor-specific survival. Results: The study cohort comprised 41 patients, including 30 (73.2%) with primary tumors and 11 (26.8%) with recurrent tumors. Open TPE was performed on five patients (12.2%) and laparoscopic TPE on the remaining 36 (87.8%). All procedures were successfully completed with a fascial space priority approach and there were no intraoperative deaths. R0 resection was achieved in 34 patients (82.9%) and R1 resection in seven (17.1%). The operation time was 500 (265-740) min, and the amount of bleeding 200 (10-3,500) mL. Twelve patients (29.3%) developed postoperative complications, two of which were Clavien-Dindo Grade III complications. One of these patients required re-operation to manage a pelvic hematoma 29 days after the primary TPE. No active bleeding was observed during the re-operation. Another patient underwent interventional angiography for an episode of postoperative bleeding; this showed a pseudoaneurysm of the internal iliac artery that was successfully treated by interventional embolization via the internal iliac artery. Five days after undergoing a primary TPE with bladder preservation, a third patient was found to have a urinary fistula and underwent laparoscopic bladder resection with percutaneous ureterostomy. The median duration of follow-up was 18 (1-90) months. The 5-year RFS and overall survival were 46.7% and 52.2%, respectively, whereas the 5-year tumor-specific survival was 67.8%. Univariate Cox regression analysis identified a positive surgical margin (P < 0.001), lateral pelvic sidewall invasion (P=0.014), and vascular invasion (P=0.004) as significantly associated with RFS, whereas multivariate analysis identified only a positive surgical margin (HR: 21.93, 95% CI: 3.78-127.42, P<0.001) as an independent predictor of RFS. Conclusions: It is safe and feasible to perform TPE with a fascial space priority approach on patients with pelvic malignancy. Positive surgical margins are significantly associated with RFS.

Objective: To evaluate the efficacy of vacuum sealing drainage (VSD) in the comprehensive management of full-thickness perineal wound dehiscence following pelvic exenteration (PE). Methods: This study employed a descriptive case series design. We retrospectively analyzed the clinical data of 29 patients who developed postoperative perineal wound infections with full-thickness dehiscence after PE. These cases included 16 patients from the Department of General Surgery at Jiangyin People's Hospital (Jiangsu Province) and 13 patients from the Department of Colorectal Surgery at the Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital). VSD was applied to manage the dehisced wounds, with outcomes assessed based on wound healing time, complications, and follow-up data. Results: A total of 29 patients were included in the study. The operative time for PE was (498 ± 83) minutes. Among them, 23 patients underwent combined sacrococcygeal resection. The median number of VSD devices used was 28 (22, 39). The postoperative perineal wound healing time was 95 (82, 110) days in patients who underwent combined sacrococcygeal resection, 74 (63, 89) days in those without sacrococcygeal resection, 93 (79, 102) days in those treated with simple pelvic-abdominal isolation using a biological basement membrane mesh and 76 (60, 91) days in those who received combined pelvic packing with a pedicled omental flap. All patients uniformly developed Clavien-Dindo grade III complications at 2 weeks postoperatively, manifesting as perineal wound infection and dehiscence, which were successfully managed with VSD therapy. Subsequent evaluation identified delayed (>30 days) grade III complications, including enterocutaneous (3 cases) and urinary (2 cases) fistulae, all requiring surgical revision. All patients completed the follow-up at 6 months postoperatively. Three patients still presented with minimal exudate from the perineal wound, which resolved after standardized wound care and packing with alginate silver ion dressings. Four cases (13.8%) developed stoma high-output syndrome, which improved after oral medication. Eight patients (27.6%) developed adhesive intestinal obstruction, which improved with conservative treatment. Conclusions: VSD demonstrates unique advantages in managing complex wounds. For full-thickness perineal wound dehiscence after PE, VSD is a safe and effective therapeutic strategy.

Overactive bladder is a common problem affecting the UnitedKingdom adult female population. Symptoms include urinary urgency, with or without urgency incontinence, increased daytime urinary frequency and nocturia. Initial conservative treatments for overactive bladder are unsuccessful in 25-40% of women (refractory overactive bladder). Before considering invasive treatments, such as botulinum toxin injection-A or sacral neuromodulation, guidelines recommend urodynamics to confirm diagnosis of detrusor overactivity. However, the clinical and cost effectiveness of urodynamics has never been robustly assessed. To compare the clinical and cost effectiveness of urodynamics plus comprehensive clinical assessment versus comprehensive clinical assessment only in the management of refractory overactive bladder in women. Parallel-group, multicentre, superiority, open-label, randomised controlled trial. Allocation by remote web-based randomisation (1 : 1 ratio). The cost-effectiveness analysis took the National Health Service perspective with a model-based lifetime time horizon, as informed by a within-trial analysis. Sixty-three UnitedKingdom secondary and tertiary hospitals. Women aged ≥ 18 years with refractory overactive bladder or urgency-predominant mixed urinary incontinence who had failed conservative management and pharmacological treatment and were being considered for invasive treatment. Women were excluded if any of the following criteria were met: predominant stress urinary incontinence; previous urodynamics in last 12 months; current pelvic malignancy or clinically significant pelvic mass; bladder pain syndrome; neurogenic bladder; urogenital fistulae; previous treatment with botulinum toxin injection-A or sacral neuromodulation for urinary incontinence; previous pelvic radiotherapy; prolapse beyond introitus; pregnant or planning pregnancy; recurrent urinary tract infection where a significant pathology has not been excluded; and inability to give an informed consent. Urodynamics plus comprehensive clinical assessment (urodynamics arm) versus comprehensive clinical assessment only. Participant-reported success at the last follow-up time point as measured by the Patient Global Impression of Improvement. Primary economic outcome was incremental cost per quality-adjusted life-year gained as modelled over the lifetime of participants. A total of 1099 participants were included: 550 randomised to the urodynamics arm and 549 to the comprehensive clinical assessment only arm. At the final follow-up time point, participant-reported success rates of 'very much improved' and 'much improved' were not superior in the urodynamics arm (117 participants; 23.6%) comparedto the comprehensive clinical assessment only arm (114 participants; 22.7%) [adjusted odds ratio 1.12 (95% confidence interval 0.73 to 1.74); p = 0.601]. Serious adverse events were low and similar between groups. Based on the estimated incremental costs and quality-adjusted life-years of urodynamics (£463 and 0.011, respectively), the incremental cost-effectiveness ratio was £42,643 per quality-adjusted life-year gained. The cost-effectiveness acceptability curve shows that urodynamics has a 34% probability of being cost-effective at a willingness-to-pay threshold of £20,000 per quality-adjusted life-year gained. This probability reduced further when the results were extrapolated over the patient's lifetime. Limitations include: only short-term outcomes were available, and as most participants underwent botulinum toxin injection-A treatment, pre-planned secondary analyses for some outcomes such as sacral neuromodulation were not possible. Participant-reported success in the urodynamics arm was not superior to the comprehensive clinical assessment only arm at 15-months follow-up. Urodynamics is not cost-effective at athreshold of £20,000 per quality-adjusted life-year gained. Longer-term follow-up is required to explore need for further interventions and treatments and their effect on the clinical and cost-effectiveness analyses. This trial is registered as ISRCTN63268739. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 15/150/05) and is published in full in Health Technology Assessment Vol. 29, No. 27. See the NIHR Funding and Awards website for further award information.

BackgroundSystematic reviews (SRs) have affirmed the efficacy of barbed sutures (BS), but raise safety concerns, particularly in adverse events (AEs). We conducted a cross-sectional study to comprehensively collate SRs on BS, summarize the incidence of AEs, and analyze the characteristics of the reported indicators.MethodsA thorough search was conducted in PubMed, Embase, China National Knowledge Infrastructure, Wanfang Database, China Biology Medicine disc and VIP Database from inception to April 14, 2025, and the methodological quality was evaluated using AMSTAR-2. AE characteristics of the SR were evaluated utilizing a self-developed item evaluation form.ResultsA total of 52 SRs were included, encompassing 15 surgical procedures and 32 AEs. In terms of methodological quality, 1 SR was rated as high, 5 as moderate, 10 as low, and 36 as critically low. Notably, 92.0% of the SRs did not provide definitions for AEs, 76.0% did not consider severity grading, and none of the SRs assessed the adequacy of sample size. The use of BS significantly reduced the occurrence of needle pricks and biliary fistulas, in addition to increase the rates of suture breakage. Statistically insignificant results included wound dehiscence, blister, exudation, peri − incisional erythema, aseptic redness, hematoma, bleeding, urinary fistulae, stitch abscess, cellulitis, anastomotic stenosis and leak. Inconsistencies were observed in ecchymosis, vaginal cuff dehiscence, postoperative leakage rate after radical prostatectomy, infection, anastomotic bleeding, and overall postoperative complications across different SRs.ConclusionEvidence from SRs has demonstrated advantages as well as certain disadvantages of BSs — such as an increase in the likelihood of suture breakage and wound-related complications. Current evidence remains inadequate and inconsistent, due to lack of definitions for AEs, severity grading, sample size assessments, and details on suture brand and location of use.

To investigate the feasibility and safety of robot-assisted partial nephrectomy (RAPN) to treat large (T2) cystic renal-cell carcinoma. A multinational study was conducted worldwide. Patients with renal tumors larger than 7cm who underwent partial nephrectomy between December 2007 and July 2017 were recruited retrospectively. The patients were divided into solid tumor group (143 cases) and cystic tumor group (28 cases). Baseline parameters, tumor characteristics, perioperative variables, and pathological outcomes were collected. Between cystic and solid tumors, no statistically significant differences were detected in age, gender, BMI, ASA score, clinical tumor size, laterality, or R.E.N.A.L nephrometry score. Operating time, warm ischemic time, estimated blood loss, complications, histology outcomes, and margin status were comparable. Pathology of 6 cystic tumors came back benign (21.4%). In solid tumors, 6 intraoperative bleeding require transfusion, 1 ureteral damage, and 3 postoperative urinary fistulas were observed. In cystic tumors, conversion to radical nephrectomy happened in one case, because of sticky fat and the risk of cyst rupture. In two cases, postoperative bleeding was treated with embolism. The longest follow-up was 113 months. In cystic group, 1 recurrence or metastasis was observed, while in solid group, 14 cases were observed. RAPN can be safely performed to treat large (T2) cystic renal-cell carcinoma. Patients with cystic renal-cell carcinoma exhibited favorable renal function recovery after robot-assisted partial nephrectomy (RAPN), which maximally preserved normal renal tissue and its function. Further studies are needed to better understand the role of RAPN for these challenging cases.

Abstract Introduction Iatrogenic nephrocutaneous fistulas (NCF) are uncommon occurring in 2-10% of partial nephrectomies. Treatment typically involves a ureteric stent with an indwelling catheter or percutaneous nephrostomy. However persistent fistula tracts can be a therapeutic conundrum. N-butyl-2-cyanoacrylate has been effectively used in various surgical fields, including urinary fistulas. Case Presentation A 61-year-old female developed a fistulous tract to the lower pole of her right kidney presenting with two small outflow holes and watery pus seepage. She underwent fluoroscopic embolisation with 1:1 "magic glue" in July 24. Due to recurring seepage, an imperative second procedure with 4.75mm brush debridement and a second embolisation using 1:1 "magic glue" was performed in September 24. Method A retrospective literature review identified very few case reports and series due to limited data on this sealant for urinary fistulas, highlighting two case series on outcomes of urinary fistulas treated with N-butyl-2-cyanoacrylate. Results A 9-year case series reported 84.6% success rate (11/13) in treating genitourinary fistulas with 2 failed cases having diameters &amp;gt;1 cm. The median follow-up was 35 months with no relapses. Another 2013 series showed 80% successful occlusion rate (4/5) using 2-5cc cyanocrylate glue, with clinical and radiological resolution at 11-month median follow up. Conclusions We observed an initial improvement in urinary leakage after applying cyanoacrylate glue, but a repeat procedure after 2 months was necessary for full resolution. Success is predicted by the tract's length-to-diameter ratio with &amp;gt;1cm and short tracts indicating poor prognosis, necessitating careful patient selection. We propose a consensus document for the same.

Abstract A vesicouterine fistula is an abnormal connection between the bladder and the uterus. It is a rare condition constituting 1-4% of urogenital fistulas. Its prevalence has increased in recent years due to the rising number of cesarean sections. Ultrasonography, cystoscopy, cystography, hysterosalpingography, computed tomography and magnetic resonance imaging methods are used in the diagnosis. Treatment options include conservative, medical and surgical methods. Surgical treatment is considered as the definitive solution. In this article, a case of uterovesical fistula after the third cesarean section was treated with surgical technique and presented with a review of the literature.

Ureteral obstruction, vesicoureteral reflux (VUR), and urine leak constitute the most common urological complications following pediatric kidney transplantation (KT). Redo ureteroneocystostomy (UNC) is one of the methods used in the treatment of these complications. This study aims to systematically review the available evidence regarding the success and complications associated with redo UNC in pediatric KT recipients. This systematic review (SR) focused on studies examining the success and complications of redo UNC in pediatric KT recipients, limited to English-language publications. The SR was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines with the searches encompassing databases of Web of Science, PubMed, and Scopus. After screening 253 abstracts, nine studies with a total of 78 patients were included. The most common indication for redo UNC was VUR (50/78, 64.1%), followed by obstruction (19/78, 24.4%), urine leak (5/78, 6.4%), urinary fistula (3/78, 3.8%), and ureteral necrosis (1/78, 1.3%). The extravesical method was used in 15 patients, with the modified Lich-Gregoir technique being the most frequent. The intravesical approach, most commonly the Cohen technique, was used in 14 patients. The average success rate for redo UNC was 91.4%. Postoperative complications included urinary tract infections and urinary obstruction. Based on currently limited available data, redo UNC is an effective and safe option for pediatric KT recipients with ureteral complications. PROSPERO: CRD42024592989.

Radical prostatectomy and radiation therapy, which are standard treatments for prostate cancer, are associated with various short- and long-term complications. Early post-prostatectomy complications include bleeding, vesicourethral anastomotic dehiscence, and anorectal injury, while late sequelae include urinary incontinence, anastomotic stenosis, urinary strictures and fistulas, osteomyelitis, and cancer recurrence. Radiation therapy can lead to bladder and bowel toxicity and, in rare cases, secondary malignancies. Imaging plays a crucial role in detecting and managing these complications. Multiphasic CT is preferred for detecting acute hemorrhage and urine leaks, while MRI is the modality of choice for evaluating urinary strictures, fistulas, and recurrent malignancies. Dynamic MR cystourethrography further enhances the assessment of urethral mobility and function, improves the detection of urinary fistula, and helps in surgical planning. MRI and PSMA PET imaging are key modalities for detecting post-treatment recurrence. As survival rates continue to improve for prostate cancer patients, the emphasis is shifting toward preserving quality of life and managing long-term treatment-related complications. In this review, we present a detailed overview of post-treatment surgical bed complications, emphasizing the role of various imaging modalities in the detection, characterization, and management of these complications.