Urinary Fistula Research Articles

Study of Factors Influencing the Results of Urogenital Fistula Surgery at Brazzaville University Hospital in Congo

Study of Factors Influencing the Results of Urogenital Fistula Surgery at Brazzaville University Hospital in Congo

Primary robot-assisted laparoscopic partial nephrectomy for hemorrhage secondary to angiomyolipoma: a retrospective study from a large tertiary hospital in China

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.

Current Potential Outcomes of Buccal Mucosal Graft Anterior Urethroplasty for Male Urethral Stricture: A Single-Centre Study in Nepal.

Objective This study evaluates the efficacy and potential complications of Buccal Mucosal Graft (BMG) urethroplasty for anterior urethral stricture over a 48-month follow-up. Method A retrospective review was conducted on 130 patients who underwent various types of BMG urethroplasty between 2012 and 2019. Data on patient demographics, stricture etiology, and anatomic sitewere collected. Adverse outcomes such as complications likeerectile dysfunction (ED)persisting for over 12 months, and post-micturition dribbling (PMD) were analyzed to determine success rates, recurrent stricture risk factors, complications, and the definition of failure as stricture recurrence during the 48-month follow-up period. Results Of the 130 patients, there was a recurrence in 15.4 % (20 males), yielding a success rate of 84.6% (n=110). ED was reported in 11% (n=14) and PMD in 14% (n=18). All instances of ED were non-organic, and patients were administered oral phosphodiesterase type 5 (PDE5) inhibitors. These complications were observed in 20 patients (15.4%); with urinary fistula (3.0%), graft contracture (2.3%), graft failure (3.8%), urinary tract infection (UTI) (3.0%), and wound infection (2.3%) being the most prevalent after penile urethroplasty. Univariate analysis indicated age (31-50 years, >50 = P<0.05) at surgery, etiology (Balanitis Xerotica Obliterans (BXO)= P<0.05), stricture length (4.1-8 cm, >8 cm = P<0.05), and location as significant predictors of stricture recurrence. However, multivariate analysis highlighted penile location (P<0.05) as the sole independent predictor for restricture during the follow-up period. Conclusion BMG urethroplasty demonstrates a substantial 84.6% success rate in treating anterior urethral stricture over a 48-month follow-up period. This outcome underscores the advancements in healthcare quality in resource-limited settings in countries like Nepal.

Transanal circumferential pouch advancement for treatment of pouch vaginal fistulae

BackgroundIleal pouch anal anastomosis (IPAA) circumferential pouch advancement (CPA) involves full-thickness transanal 180–360° dissection of the distal pouch, allowing the advancement of healthy bowel to cover the internal opening of a vaginal fistula. We aimed to describe the long-term outcomes of this rare procedure.MethodsPatients with IPAA who underwent transanal pouch advancement for any indication between 2009 and 2021 were included. Demographics, operative details, and outcomes were reviewed. An early fistula was defined as occurring within 1 year of IPAA construction. Clinical success was defined as resolution of symptoms necessitating CPA, pouch retention, and no stoma at the time of follow-up. Figures represent the median (interquartile range) or frequency (%).ResultsOver a 12-year period, nine patients were identified; the median age at CPA was 41 (36–44) years. Four patients developed early fistula after index IPAA, and five developed late fistulae. The median number of fistula repair procedures prior to CPA was 2 (1–2). All patients were diagnosed with ulcerative colitis at the time of IPAA and all late patients were re-diagnosed with Crohn’s disease. Four (44.4%) patients had ileostomies present at the time of surgery, three (33.3%) had one constructed during surgery, and two (22.2%) never had a stoma. The median follow-up time was 11 (6–24) months. Clinical success was achieved in four of the nine (44.4%) patients at the time of the last follow-up.ConclusionsTransanal circumferential pouch advancement was an effective treatment for refractory pouch vaginal fistulas and may be offered to patients who have had previous attempts at repair.

Evaluation of Latrogenic Genitourinary Fistula after Major Gynaecological Operation in Patient Group Admitted in BSMMU

Introduction: Close proximity of urinary tract and genital systems in females poses potential risk of fistulas formation during surgical interventions. Gynaecological malignancy, bleeding, prolonged surgery, the presence of active infection during operation, endometriosis, large uterus, previous pelvic operation, pelvic adhesions and myoma uteri are major predisposing factors that may increase the risk of urological injuries &amp; genitourinary fistulas. Genitourinary fistulas result in continuous or intermittent urinary incontinence and a significant public health issue with negative physical, emotional and social impacts on individuals. Materials and Methods: This cross sectional observational study was conducted in Department of Obstetrics &amp;Gynaecology, Bangabandhu Sheikh Mujib Medical University, Dhaka, from 27th March 2017 to 26th September 2017. The sample was collected by purposive sampling technique. The study subjects were women with iatrogenic fistula (diagnosed after a clinical examination and investigations) attended in out-patients or in-patients department. Result: Mean age of patients was 32.5 ± 9.54 years. Vesicovaginal fistula was commonest cause for iatrogenic genitourinary fistula, present in 34 patients. Ureterovaginal fistula was 10 patients and 6 patients detected urethrovaginal. Aetiological factors revealed that, 46.0% occurred during vaginal hysterectomy, 18.0% due to abdominal hysterectomy, 20.0% due to laparotomy with salphingoophorectmy and 16.0% during laparotomy with cystectomy. Conclusion: The commonest urogenital fistula is the vesicovaginal fistula. Urinary leakage following gynaecological surgery is a dreaded complication due to the formation of urogenital fistula. Thorough evaluation, using all diagnostic tools for complete diagnosis, understanding the pathophysiology and choosing the best surgical procedure are mandatory to obtain good outcomes after the surgical procedures. Medicine Today 2024, Vol.36 (2): 110-113

Practical use of transanal decompression tube following the repair of fourth-degree perineal tears associated with vaginal delivery

BackgroundFourth-degree perineal tears associated with vaginal delivery (PTAVD) occur in approximately 0.25 to 6% of vaginal deliveries. A persistent challenge in treating fourth-degree PTAVD is the high incidence of anastomotic leakage, leading to impaired quality of life, marked by incontinence, rectovaginal fistula, and painful sexual intercourse. Thus, effective interventions are necessary. Herein, we report our successful approach in repairing a fourth-degree PTAVD, involving the placement of a transanal decompression tube (TDT) during the early postoperative period.Case presentationFive patients underwent the repair of fourth-degree PTAVD by suturing the mucosal and muscular layers of the rectum, and the vaginal wall in layers. Subsequently, a TDT was placed in the rectum, positioned 10–15 cm from the anal verge. The TDT was allowed to drain spontaneously without suction. Gastrografin enema examination was performed through a TDT, followed by a computed tomographic scan on postoperative days 3–4. After unfavorable complications were ruled out, the TDT was removed and the patients were transitioned to a normal diet.ResultAll patients showed favorable outcomes with no occurrence of vaginal fistula or incontinence.ConclusionThis simple intervention demonstrates potential efficacy in reducing anastomotic leakage following the repair of fourth-degree PTAVD.

Correlates of fertility desires in women with urogenital fistula in the Democratic Republic of Congo: a cross-sectional study of 1,646 women

BackgroundStudies on fertility desires among fistula patients in the Democratic Republic of Congo (DRC) have been conducted on fewer patients. Furthermore, these studies have adopted a univariate descriptive approach. This study aims to examine the determinants of fertility desires among patients with fistula in the DRC.MethodsThis cross-sectional study included women aged 15–49 whose fistulas were repaired by the Panzi Hospital mobile team in seven DRC regions between 2013 and 2018. Univariate and bivariate descriptive analyses were performed using the frequency distribution table and the chi-square test. Adjusted odds ratios with their 95 confidence intervals from logistic regression were used to analyze factors associated with fertility desire after fistula repair. All analyses were stratified by parity level for all women aged 15–49 and 20–34 years.ResultsOf the 1,646 women aged 15–49 and 808 aged 20–34, 948 (57.6%) and 597 (73.8%), respectively, wanted to have children after fistula repair. Among women aged 15–49 and 20–34 years, the desire to have children was parity-specific. It was negatively associated with age at all parity levels. In women with low parity, the desire for children was significantly negatively associated with a high number of surgeries, abortions, and fistula duration. It tended to decrease with time, but was particularly high in 2014 and 2017. It was high among the Protestant women. Among medium-parity women, it was significantly lower in urban areas and among widows, but higher among women who had more than two abortions. Among high-parity women, it was negatively associated with education level.ConclusionTo help women with fistula achieve or approach their desired number of children, our findings suggest that (1) counseling is needed for women with a high desire for children; (2) the human, material, and financial resources needed to eliminate fistula in the DRC should be made available; and (3) medical and nursing staff should be sufficiently and effectively trained to minimize the number of unsuccessful surgeries performed on women with fistula.

Using interpretive description to facilitate women's contributions to maternity care: experiences and views of obstetric fistula prevention

Background/Aims Interpretive description is a qualitative methodology that combines detailed descriptions with thoughtful interpretation. This approach is especially effective for producing practical insights and deepening the understanding of phenomena in clinical or practice-based settings. The aims of this study were to explore how interpretive description could be used to research the experiences and views of women with obstetric fistula. Methods Interpretive description was used to explore the experiences and views of 15 purposively selected women affected by obstetric fistula. Participants were recruited via the Evangel Vesico Vaginal Fistula Centre of Bingham University Teaching Hospital. Data were collected via in-depth interviews and concurrently analysed thematically. Results Interpretive description provided women with a unique opportunity to share their experiences of the causes and avoidable risk factors of obstetric fistula. The approach yielded qualitative findings and allowed for the representation of different views, leading to an understanding of how to mitigate obstetric fistula in the community. Conclusions Interpretive description was used to listen to the voices of women affected by obstetric fistula, learn from their experiences and highlight the interventions that may alter risk factors for the condition in the community. This is the first study to use interpretive description to facilitate under-represented women's contributions to maternity care by listening to their experiences and views. This enabled identification of gaps in maternity care provision, which would be of interest to the community and health service leaders as well as policymakers in sub-Saharan Africa. Implications for practice Interpretive description allows for deep capture of women's perspectives, allowing implementation of interventions designed to target issues as perceived by those most affected. This also ensures that under-represented groups are included in the research process.

Long-term ileoanal pouch survival after pouch urinary tract fistulae

BackgroundIleoanal 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.MethodsOur 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).ResultsOver 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).ConclusionPouch-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.

Equivalence between physicians and associate clinicians in the frequency of iatrogenic urogenital fistula following cesarean section in Tanzania and Malawi

BackgroundPhysicians and associate (non-physician) clinicians conduct cesarean sections in Tanzania and Malawi. Urogenital fistulas may occur as complications of cesarean section. Location and circumstances can indicate iatrogenic origin as opposed to ischemic injury following prolonged, obstructed labor.MethodsThis retrospective review assessed the frequency of iatrogenic urogenital fistulas following cesarean sections conducted by either associate clinicians or physicians in Tanzania and Malawi. It focuses on 325 women with iatrogenic fistulas among 1290 women who had fistulas after cesarean birth in Tanzania and Malawi between 1994 and 2017. An equivalence test compared the proportion of iatrogenic fistulas after cesarean sections performed by associate clinicians and physicians (equivalence margin = 0.135). Logistic regression was used to model the occurrence of iatrogenic fistula after cesarean section, controlling for cadre, date, maternal age, previous abdominal surgery and parity.ResultsAssociate clinicians attended 1119/1290 (86.7%) cesarean births leading to fistulas, while physicians attended 171/1290 (13.3%). Iatrogenic fistulas occurred in 275/1119 (24.6%) cesarean births by associate clinicians and in 50/171 (29.2%) cesarean births by physicians. The risk difference and 90% confidence interval were entirely contained within an equivalence margin of 13.5%, supporting a conclusion of equivalence between the two cadres. The odds of iatrogenic fistula after cesarean section were not statistically significantly different between associate clinicians and physicians (aOR 0.90; 95% CI 0.61–1.33).ConclusionsAssociate clinicians appear equivalent to physicians performing cesarean sections in terms of iatrogenic fistula risk. Lower iatrogenic proportions for associate clinicians could reflect different caseloads. The occurrence of iatrogenic fistulas illustrates the importance of appropriate labor management and cesarean section decision-making, irrespective of health provider cadre. Given the noninferior performance and lower costs of employing associate clinicians, other countries with insufficient and/or unequally distributed health workforces could consider task-shifting cesarean sections to associate clinicians.

Management of vaginoplasty canal complications.

Increasing uptake of gender affirming surgery has allowed for a wider breadth of publication examining complications associated with vaginoplasty. This review aims to provide a comprehensive overview of complications associated with vaginoplasty procedures, focusing on intraoperative, early postoperative, and delayed postoperative complications across different surgical techniques. Intraoperative complications such as bleeding, injury of the rectum, urethra and prostate, and intra-abdominal injury are discussed, with insights into their incidence rates and management strategies. Early postoperative complications, including wound dehiscence, infection, and voiding dysfunction, are highlighted alongside their respective treatment approaches. Moreover, delayed postoperative complications such as neovaginal stenosis, vaginal depth reduction, vaginal prolapse, rectovaginal fistula, and urinary tract fistulas are assessed, with a focus on their etiology, incidence rates, and management options. Vaginoplasty complications range from minor wound issues to severe functional problems, necessitating a nuanced understanding of their management. Patient counseling, surgical approach, and postoperative care optimization emerge as crucial strategies in mitigating the impact of complications. Standardizing complication reporting and further research are emphasized to develop evidence-based strategies for complication prevention and management in vaginoplasty procedures.

En Bloc Simultaneous Liver–Kidney Transplantation Compared to the Traditional Technique: Results From a Single Center

Introduction: 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.Objective: To compare the outcomes of the traditional and en bloc techniques for simultaneous liver-kidney transplantation in a single center.Methods: Single-center retrospective study involving all adult patients who underwent simultaneous liver-kidney transplantation with brain-dead donors from January/2017 to December/2022.Results: A total of 15 patients were included, being 10 transplanted with the traditional technique and 5 with the en bloc one. Patients in the en bloc group presented higher body mass index, shorter cold and total kidney ischemia time, shorter overall surgical time and longer kidney ischemia time (29.07 vs 23.20kg/m2, p=0.048; 560 vs 880min, p=0.026; 615 vs 908min, p=0.025; 405 vs 485min, p =0.046; 46 vs 33.5min, 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 two cases of renal vein thrombosis and one of ureteral stenosis.Conclusion: Compared to the traditional technique, the en bloc approach is feasible and safe, reducing the total surgical and kidney ischemia times.

Adolescent female reproductive system dysplasia: a clinical study of 356 cases

Objective: To explore the age of onset and consultation, the main clinical manifestations, common types of combined malformations, the relationship of endometriosis, surgical prognosis and different types of proportion of adolescent female reproductive system dysplasia. Methods: The medical records of 356 patients (aged 10-19) with female reproductive system dysplasia in Women's Hospital, School of Medicine, Zhejiang University from January 2003 to August 2018 were collected and retrospectively analyzed. Results: (1) Among the 356 adolescent dysplasia patients, uterine dysplasia (23.6%, 84/356), oblique vaginal septum syndrome (OVSS; 22.5%, 80/356) and vaginal dysplasia (21.6%, 77/356) were the most frequent ones, followed by multi-sectional dysplasia (16.0%, 57/356), other types of developmental abnormalities like external genitaliaand urogenital fistula (13.5%, 48/356) and Mayer-Rokitansky-Küster-Hauser syndrome (MRKH syndrome; 2.8%, 10/356). (2) There were significant differences between the median age of onset and the age of consultation of patients with OVSS and other types of abnormalities except hymen atresia (both P<0.05). In contrast, there were no significant differences between the age of onset and the age of consultation of the patients of uterine dysplasia, vaginal dysplasia, hymen atresia, MRKH syndrome and multi-sectional dysplasia (all P>0.05). (3) The clinical manifestations were lack of specificity, and mainly abnormal finding was lower abdominal pain. (4) After admission, the majority of patients underwent comprehensive cardiopulmonary examination (71.3%, 254/356) and urinary system examination (63.5%, 226/356). Only 18.3% (65/356) of patients had completed abdominal organ examination, and 5.9% (21/356) skeletal system examination. About other systemic malformations, urological malformations were the most common (27.5%, 98/356), followed by anorectal malformation (0.6%, 2/356), heart malformations (0.3%, 1/356), and spinal malformations (0.3%, 1/356). 46.4% (84/181) of the surgical patients were diagnosed with combined endometriosis. Patients with obstructive genital tract malformations were more likely to combine with endometriosis than non-obstructive ones [50.3% (74/147) vs 29.4% (10/34); P<0.05]. However, there was no significant difference between the severity of endometriosis of those two kinds (P>0.05). (5) Totally 308 patients were followed up successfully with a median of 25.0 years old, and 20 cases were treated again; 12.0% (37/308) of them were suffering from menstrual disorder and 33.1% (102/308) of them with dysmenorrhea. Totally 130 patients had sexually active reported no sexual problems. Conclusions: Uterine dysplasia, OVSS and vaginal dysplasia are the most common syndromes in adolescent female reproductive system dysplasia along with frequent cases of coexisting urinary malformations and increasing risks of endometriosis. Meanwhile, the lack of specificity of clinical manifestations might delay the timely diagnosis and treatment after the onset of symptoms. Nonetheless, most patients could achieve good surgical outcomes.

Female non-obstetric urogenital fistula repair: long-term patient-reported outcomes and a scoping literature review.

To investigate long-term and patient-reported outcomes, including sexual function, in women undergoing urogenital fistula (UGF) repair, addressing the lack of such data in Western countries, where fistulas often result from iatrogenic causes. We conducted a retrospective analysis at a tertiary referral centre (2010-2023), classifying fistulas based on World Health Organisation criteria and evaluating surgical approaches, aetiology, and characteristics. Both objective (fistula closure, reintervention rates) and subjective outcomes (validated questionnaires) were assessed. A scoping review of patient-reported outcome measures in UGF repair was also performed. The study included 50 patients: 17 (34%) underwent transvaginal and 33 (66%) transabdominal surgery. History of hysterectomy was present in 36 patients (72%). The median (interquartile range [IQR]) operating time was 130 (88-148) min. Fistula closure was achieved in 94% of cases at a median (IQR) follow-up of 50 (16-91) months and reached 100% after three redo fistula repairs. Seven patients (14%) underwent reinterventions for stress urinary incontinence after transvaginal repair (autologous fascial slings). Patient-reported outcomes showed median (IQR) scores on the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Modules (ICIQ-FLUTS) of 5 (3-7) for filling symptoms, 1 (0-2) for voiding symptoms and 4.5 (1-9) for incontinence symptoms. The median (IQR) score on the ICIQ Female Sexual Matters Associated with Lower Urinary Tract Symptoms Module (ICIQ-FLUTSsex) was 3 (1-5). The median (IQR) ICIQ Satisfaction (ICIQ-S) outcome score and overall satisfaction with surgery item score was 22 (18.5-23.5) and 10 (8.5-10), respectively. Higher scores indicate higher symptom burden and treatment satisfaction, respectively. Our scoping review included 1784 women, revealing mixed aetiology and methodological and aetiological heterogeneity, thus complicating cross-study comparisons. Urogenital fistula repair at a specialised centre leads to excellent outcomes and high satisfaction. Patients with urethrovaginal fistulas are at increased risk of stress urinary incontinence, possibly due to the original trauma site of the fistula.

Radiographic, ultrasonographic and surgical treatment of rectovaginal fistula disease associated with atresia ani in ruminants

Recto–vaginal fistula (RVF) associated with atresia ani (AA) are congenital anomalies in which fecal and urinary output occurs through the vulvar region. In this study, 17 ruminants (lamb n=9, calf n=8) constituting type II AA–associated RVF cases were included. The cases were evaluated clinically, radiographically and ultrasonographically. Clinical findings included tenesmus, feces in the perivulval area, abdominal distension, partial perineal swelling and hematochezia. The abdomen and pelvis were evaluated by direct radiography and gaseous distension, dilated colon, moderate or severe megacolon were diagnosed. Using radiographic assessment of the distance between the rectum blind pouch and perineum, AA was typed and all cases were diagnosed as Type II AA. Ultrasonography was used to classify RVF and recto–lower fistula was diagnosed in all cases evaluated. All operations were performed by anoplasty using the rectal–pull through technique. No complications were encountered during the postoperative follow–up period. The aim of this study was to provide information about the diagnosis, treatment and use of radiography and ultrasonography in Type II AA with RVF in lambs and calves.

The utility of Martius fat pad in the repair of urogenital fistulae: review of current evidence.

To present the contemporary evidence on transvaginal urogenital fistulae (UGF) repair withMartius fat pad (MFP), compared to direct graftless fistula repair. We reviewed all available studies reporting lower UGF repair via the transvaginal approach in MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). The primary outcome of interest was the fistula closure rates. When available, patients' baseline characteristics, indications for surgery, and early and late postoperative complications with focus on MFP-related complications are reported. In obstetric fistulae, tissue interposition has been almost completely abandoned, with contemporary large series reporting closure rates of >90% with graftless repair, even for complex fistulae. Similarly, most simple, non-irradiated iatrogenic fistulae can be closed safely without or with tissue interposition with success rates ranging between 86% and 100%. However, MFP is valuable in fistulae with difficulty achieving tension-free and layered closure, with significant tissue loss, urethral involvement and with poorly vascularised tissues after radiotherapy, with reported success rates between 80% and 97% in those challenging situations. A UGF repair should be individualised after considering the specific characteristics and complexity of the procedure. MFP interposition is probably unnecessary for the majority of low (obstetric) fistulae within otherwise healthy tissues. However, MFP may still have a place to maximise outcomes in low-income settings, in select cases with higher (iatrogenic) fistulae, and in most cases with radiotherapy.

Safety and Feasibility of Single-Port Nephroscopy Combined with a Needle Electrode Technique to Treat Dorsal Simple Renal Cysts

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.

Ureterocutaneous Fistula in the Setting of Recurrent Gluteal Abscesses: A Case Report

Ureteral fistulas are a rare occurrence that can arise from iatrogenic trauma, radiation, malignancy, and inflammation. Treatment options of urinary tract fistulas are handled on a case-by-case basis, and can necessitate a surgical approach. The authors present the case of an 85-year-old female patient with a ureterocutaneous fistula, where conservative management with percutaneous nephrostomy is a viable alternative to surgical intervention.

Transcatheter renal arterial embolization for intractable urinary fistula occurring after robot-assisted partial nephrectomy: a case report.

Partial nephrectomy is the standard surgical procedure for small renal tumors. Since the advent of robot-assisted partial nephrectomy (RAPN), the number of cases of renal tumors undergoing the procedure has increased exponentially. Urinary fistula is a complication of partial nephrectomy. Conservative management using ureteral stents is useful in most cases of urinary fistulas. However, some patients develop intractable urinary fistulas. Herein, we report a case in which vascular embolization was useful for treating an infected and intractable urinary fistula that developed after RAPN. A 59-year-old man was accidentally found to have a right renal tumor (approximately 3cm in diameter) during a physical examination. Pathology was clear cell carcinoma. RAPN was performed owing to the small size of the renal tumor; however, postoperatively, an intractable urinary fistula with an isolated calyx developed, which was successfully treated with transcatheter renal arterial embolization (TAE). We encountered a rare case of infected refractory urinary fistula with an isolated calyx in which TAE was successful. TAE seems useful in treating intractable urinary fistulas with an isolated calyx occurring after RAPN.

Genitourinary Fistula: epidemiology, changing trends in etiology and management: A tertiary care institute's perspective.

Urogenital fistula is a physically, socially and psychologically devastating condition for the patient. In developed countries, these fistulae are typically related to gynecological surgery, pelvic pathology like malignancy or post radiation therapy. In contrast, classical teaching is that urogenital fistulae in the developing countries like India are usually associated with prolonged labor and obstetric complications. This retrospective study conducted at a tertiary care health Institute shows a paradigm shift in epidemiology, etiology and management of genitourinary fistulae in India in recent times. This retrospective study included patients undergoing surgical repair for various genitourinary fistulae at our institute from 2016 to 2022. Epidemiology, etiology, site, size and number of fistulae, clinical presentation, and management records of these patients were recorded and reviewed retrospectively. In our study, the mean age of the patients was 38.4 ± 10.2 years. Vesicovaginal Fistula (VVF) was found to be most common fistula in the study population (87.5%) followed by vesicouterine (7.1%) and urethrovaginal fistula (5.4%). The causes of genitourinary fistula were iatrogenic (73.2%), carcinoma of cervix (16.1%), obstructed prolonged labor (7.1%), and genitourinary tuberculosis (3.57%). Among the 48 vesicovaginal fistulas that underwent surgery, 45.8% were treated using a transvaginal approach, 29.2% were managed through a laparoscopic transabdominal repair, and 25% were addressed using a robotic approach. Recurrence occurred in 7.1% of the operated patients. Enhanced healthcare services in the country have contributed to a decrease in the incidence of obstructed labor, subsequently reducing related injuries. Iatrogenic injuries resulting from gynecological surgeries and carcinoma cervix have given rise to more complex fistulas, necessitating the implementation of advanced treatment strategies.