Urinary Fistula Research Articles

Penile Squamous Cell Carcinoma: An Inextirpable Tumor Case Report

We report a case of penis cancer at University hospital center of rabat, about a 66 years old patient with diabetes and a history of chronic smoking. The symptoms were marked by the appearance of an interscrotal perineal mass initially painless with some itching, then painful to the touch; associated with a dysuria all evolving to a scrotal urinary fistula. The diagnosis of squamous cell carcinoma was confirmed intraoperatively after an extemporaneous biopsy. The decision was to reduce the tumor volume as much as possible. Follow-up treatment after a multidisciplinary discussion was to complete with chemotherapy.

Urogenital Fistula Patients Profile at a Tertiary Hospital in Surabaya, Indonesia from 2015 to 2021

Highlights: Vesicovaginal fistula is the most common urogenital fistula. The transvaginal approach is preferred in treating urogenital fistula. Abstract: A fistula is an extra-anatomical channel between two or more hollow organs, or between an organ and the body surface. WHO estimated there were two million patients with untreated urogenital fistula, with 130,000 new cases every year. The ideal approach for urogenital fistula depends on surgeon preference and individual clinical characteristics. Accordingly, we aimed to determine the profile of patients with a urogenital fistula at a tertiary hospital of Dr. Soetomo General Academic Hospital in Surabaya, Indonesia, from 2015 to 2021. A retrospective study with a descriptive design was carried out by medical records data retrieval of patients with urogenital fistula. It included age, etiology, anatomical location, surgical management, and recurrence rate. The study population consisted of 55 patients. The majority of the patients were among the 41-50 y.o. age groups (41.17%), while the least were in the <20 years group (1.96%). History of obstructed labor was the most common etiology (70.59%). Fistulas in the study population were also associated with a history of trauma (15.68%) and malignancy (11.76%). The vesicovaginal fistula was the most common type of fistula (88.23%). Other types found include urethrovaginal, ureterovaginal, rectovesical, rectovaginal, and vesicocolon fistulas. The transvaginal approach was preferred in almost all study populations. A total of two cases of vesicovaginal fistula recurred (3.39%). In general, patients with urogenital fistula are prevalent in the 4th decade age group, with the most common etiology being a history of obstructed labor. Transvaginal surgery is the treatment of choice with good results and low recurrence rates.

The effect of staged TIP urethroplasty on proximal hypospadias with severe chordee

BackgroundProximal hypospadias with severe chordee is still a formidable challenge for most pediatric urologists, and the treatment approach remains controversial. Here, we describe a modified two-stage technique to repair proximal hypospadias with severe chordee.MethodsWe retrospectively identified 53 children referred for proximal hypospadias with severe chordee from July 2016 to July 2019, who underwent a two-stage urethroplasty. In group 1, the children were repaired with staged tubularized incised plate (TIP) urethroplasty, while Byars’ two-stage urethroplasty was attempted in group 2. We corrected chordee by releasing all remaining attachments to the corpora after degloving the penis, transceting the urethral plate, and dorsal plication. The mean age of patients in the first stage of surgery was 26.6 months in group 1 and 24.8 months in group 2. Postoperative complications in the two groups included: fistula, urethral stricture, urethral diverticulum, and glanular dehiscence.ResultsA total of 20 cases were repaired with staged TIP urethroplasty (group 1), and 33 cases were repaired with Byars’ two-stage urethroplasty (group 2). The length of follow-up in group 1 was 39.8 ± 10.1 months, and in group 2, it was 38.1 ± 8.7 months (P > 0.05). After the second stage of surgery, 1 case (5%) in group 1 and 11 cases (33.3%) in group 2 developed a urinary fistula (P < 0.05). One case (5%) in group 1 and three cases (9.1%) in group 2 had urethral stricture (P > 0.05). All strictures were cured by repeated dilation, and no patient required reoperation. No cases in group 1 and one case (3%) in group 2 had urethral diverticulum (P > 0.05). There was no residual chordee in both groups. Two cases (10%) in group 1 and 13 cases (39.3%) in group 2 required reoperation (P < 0.05).ConclusionsStaged urethroplasty is appropriate to repair proximal hypospadias with severe chordee. Particularly, staged TIP urethroplasty is a good choice for patients with proximal hypospadias and severe chordee, especially those with better penile development, wider urethral plate, larger glans, and deeper navicular fossa of the urethra.

Distal hypospadias repair: Comparative study between snodgrass and transverse preputial onlay flap

Distal hypospadias repair has several operative strategies such as tubularized incised plate (TIP); Transverse preputial onlay flap (TPOF) and Modified Mathieu Procedure. The aim of our work is to compare between TIP and TPOF techniques in the outcome. We conducted this comparative study on 66 patients with different types of distal hypospadias divided in two groups A and B for TIP and TPOF respectively. We reported outcome and complications for both TIP and TPOF repair. Our results revealed mean operative time was significantly higher in group B (123.1±6.8min) than in group A (93.73±3.9min, P value<0.001). Postoperative urinary fistula was reported in group A (15.2%) while no fistula in group B (p value=0.05). The vertical slit appearance of meatus was better in group A (54.5%) than in group B (24.2%, P value 0.023). As regard to hypospadias objective scoring evaluation (HOSE) (Summary Figure) the meatal shape score was higher in group A (1.55±0.51) than in group B (1.24±0.44, p value=0.0l), the urinary stream score was significantly higher in group A (1.82±0.39) than in group B (1.97±0.17, p value=0.04) and the urinary fistula score was significantly higher in group A (3.79±0.60) than in group B (4±0, p value=0.04). Complications are more common after TIP than in TPOF. As regard the meatus shape, the naturally looking vertical slit like meatus was achieved more in the TIP than in TPOF. We advocate further studies with a large number of patients with a long follow up period. TPOF is a great option to consider in cases of distal hypospadias because it is an effective technique for primary distal hypospadias repair with a good cosmetic outcome and a low associated complication.

Laparoscopic treatment of bilateral duplex kidney and ectopic ureter: A case report

BACKGROUNDDuplication of the renal pelvis is a common congenital malformation of the urinary system. About one-third of cases are complete unilateral duplication of the renal pelvis, while bilateral duplication is extremely rare. Herein, we described a single case of bilateral renal duplication with double ureteral orifice ectopic vaginal fistula treated with laparoscopy. CASE SUMMARYA 6-year-old girl suffering from long-term vaginal leakage was admitted on June 10, 2018. She was diagnosed with complete duplication of both kidneys and ureters and ectopic opening of both ureters combined with ureterovaginal fistula. The patient received laparoscopic ectopic ureteral bladder replantation and was followed up for 2 years. No renal function damage and vaginal leakage were found.CONCLUSIONLaparoscopic bladder-ureter reimplantation could effectively determine the location and number of ectopic ureters by imaging and cystoscopy.

A Case Report: Vesico Vaginal Fistula

Background: Vesica vaginal fistula is a part of urogenital fistula wich condition that present fistula between bladder and vagina and make urine mold through vagina. Case Report: Nullipara woman, 48 years old, admitted with complaining mold of urine from vagina since ten months ago after seven days having surgery procedure. Complaint appeared seven days after hysterctomi procedure as indication of uterine myoma. The vital signs are normal. On Per Speculum examination, clearly see there are fluids on the posterior fornix. Methylene blue test show result one fistula is at the top anterior of vagina, 6 cm proximal from hymenal ring about 1-1.5 cm. The patient underwent fistulorraphy with a vaginal approach using the futh mayo technique Discussion: Vesica vaginal fistula usually occur in the development country. Predisposition factors of it caused by hysterectomy procedure, besides trauma during labor and complications of pelvic surgery may also too. Physical and additional specific examination conventionally or minimally invasive like cystoscopy, cystography with contrast can obtain diagnosis, determine the location, size and number of fistula. Surgery is the mainstay therapy for urogenital fistula through trans vaginal or trans abdomen. Approaching depends on knowledge, experience and collaboration with other experts if needed. Surgery is the mainstay therapy for urogenital fistula through trans vaginal or trans abdomen. Approaching depends on knowledge, experience and collaboration with other experts if needed. Surgery is the mainstay therapy for urogenital fistula through trans vaginal or trans abdomen. Approaching depends on knowledge, experience and collaboration with other experts if needed.

Treatment Outcomes of Computer Tomography-Guided Brachytherapy in Cervical Cancer in Hong Kong: A Retrospective Review.

Simple SummaryThis retrospective study reviews 135 patients with locally advanced cervical cancer treated with chemo-radiotherapy with image-guided adaptive brachytherapy with CT guidance. The study has a long follow-up period of 53.6 months. The outcome was excellent with a five-year local control, pelvic control, distant metastasis-free survival and overall survival rates being 90.7%, 84.2%, 80.0% and 87.2%, respectively. Adenocarcinoma was significantly associated with worse local control, pelvic control, distant metastasis-free survival and overall survival rates.(1) Background: To report the long-term clinical outcomes of computer-tomography (CT)-guided brachytherapy (BT) for locally advanced cervical cancer. (2) Methods: A total of 135 patients with FIGO stage IB-IVA cervical cancer treated with definitive radiotherapy +/− chemotherapy with an IGABT boost at Queen Mary Hospital, Hong Kong, between November 2013 and December 2019 were included. Treatment included pelvic radiotherapy 40 Gy/20 Fr/4 weeks +/− chemotherapy then CT-guided BT (7 Gy × 4 Fr) and a sequential parametrial boost. The primary outcome was local control. Secondary outcomes were pelvic control, distant metastasis-free survival, overall survival (OS) and late toxicities. (3) Results: The median follow-up was 53.6 months (3.0–99.6 months). The five-year local control, pelvic control, distant metastasis-free survival and OS rates were 90.7%, 84.3%, 80.0% and 87.2%, respectively. The incidence of G3/4 long-term toxicities was 6.7%, including proctitis (2.2%), radiation cystitis (1.5%), bowel perforation (0.7%), ureteric stricture (0.7%) and vaginal stenosis and fistula (0.7%). Patients with adenocarcinomas had worse local control (HR 5.82, 95% CI 1.84–18.34, p = 0.003), pelvic control (HR 4.41, 95% CI 1.83–10.60, p = 0.001), distant metastasis-free survival (HR 2.83, 95% CI 1.17–6.84, p = 0.021) and OS (HR 4.38, 95% CI: 1.52–12.67, p = 0.003) rates. Distant metastasis-free survival was associated with HR-CTV volume ≥ 30 cm3 (HR 3.44, 95% CI 1.18–9.42, p = 0.025) and the presence of pelvic lymph node (HR 3.44, 95% CI 1.18–9.42, p = 0.025). OS was better in patients with concurrent chemotherapy (HR 4.33, 95% CI: 1.40–13.33, p = 0.011). (4) Conclusions: CT-guided BT for cervical cancer achieved excellent long-term local control and OS. Adenocarcinoma was associated with worse clinical outcomes. (4) Conclusion: CT-guided BT for cervical cancer achieved excellent long-term local control and OS. Adenocarcinoma was associated with worse clinical outcomes.

Urethra Reconstruction and Revision Urethroplasty in Pedicled Anterolateral Thigh Flap Penile Reconstruction.

Neophallic urethroplasty remains a significant challenge in penile reconstruction. Currently, there is no ideal recognized method. Through this article, we aimed to share our experiences of urethral reconstruction in the pedicled anterolateral thigh flap penile reconstruction using modified techniques and alternative flaps. In this single-center study from 2010 to 2020, 49 patients underwent penile reconstruction with a pedicled anterolateral thigh flap; 17 patients had a micropenis, 3 had iatrogenic defects, and 29 had penile defects after trauma. Different urethroplasty methods, complications, and revision methods were separately described. The tube-in-tube technique was used in 6 cases; the superficial iliac circumflex artery perforator (SCIAP) flap and pudendal-thigh flap were used in 26 and 11 cases, respectively, and the pedicled scrotal flap was used in 6 cases. Revision urethroplasty due to postoperative necrosis (n = 3), stricture (n = 8), and fistula (n = 2) were performed in 13 cases. The urethral complications (flap necrosis, urinary fistula, and stricture) were as follows: tube-in-tube, 66.7%; SCIAP flap, 46.2%; pudendal-thigh flap, 38.5%; and scrotal septum flap, 50%. After revision procedures, all patients could urinate while standing. The characteristics and requirements of patients should be considered before designing a surgical plan. The tube-in-tube technique is the first choice for reconstructing the penis and urethra in a single stage for thinner patients. For other patients, a different flap can be used as a substitute for urethral reconstruction. The SCIAP, pudendal-thigh, and pedicled scrotal flaps can be used to reconstruct the urethra. The tubed SCIAP flap and pudendal-thigh flap are reliable, simple, and suitable for revision urethroplasty.

Surgical outcomes and sexual function after laparoscopic colon cancer surgery with transvaginal versus conventional specimen extraction: A retrospective propensity score matched cohort study

BackgroundNatural orifice specimen extraction has been shown to reduce postoperative pain and wound complications, and provide better cosmetic outcome. However, whether transvaginal specimen extraction affects sexual function remains controversial. The purpose of this study was to investigate the short-term outcomes, sexual function, cosmetic outcomes and prognosis after colon cancer surgery with transvaginal specimen extraction. MethodThis study was a propensity score-matched comparative retrospective study, based on prospectively collected data in a single center. This study included 70 pairs of propensity score-matched female patients who underwent laparoscopic curative resection for stage I-III colon cancer with transvaginal specimen extraction and conventional specimen extraction between November 2015 and November 2020. Covariates used in the propensity score included age, tumor diameter, tumor differentiation, T stage and American Joint Committee on Cancer stage. Outcome measures included postoperative complication, postoperative sexual function, cosmetic result, disease-free survival and overall survival. ResultsPatients in transvaginal group were administered with less additional analgesics (P = 0.008), and had fewer wound complications (P = 0.028). None of patient in the two groups underwent anastomotic leakage, incisional disruption or vaginal fistula. The baseline pre-operative Female Sexual Function Index scores in two groups were the same, and no difference was found in postoperative score between the two groups (P = 0.790). The cosmetic score was significantly better in transvaginal group than that of conventional laparoscopy group (P = 0.000). During the follow-up period, there were no differences in OS or DFS between the two groups (P = 0.658, P = 0.663). ConclusionsCompared with laparoscopic colon cancer radical resection with specimen extraction, transvaginal specimen extraction is oncologically safe, brings better short-term outcomes, improved cosmetic results and has limited adverse effect on female's sexual function. This procedure can be further carried out in more appropriate patients.

Robotic surgery in gynaecology: Scientific Impact Paper No. 71 (July 2022).

The use of robotic-assisted keyhole surgery in gynaecology has expanded in recent years owing to technical advances. These include 3D viewing leading to improved depth perception, limitation of tremor, potential for greater precision and discrimination of tissues, a shorter learning curve and improved comfort for surgeons compared with conventional keyhole and open abdominal surgery. Robotic-assisted keyhole surgery, compared with conventional keyhole surgery, improves surgical performance without increasing operating time, minimises blood loss and intra- or postoperative complications, while reducing the need to revert to abdominal surgery. Moreover, surgeons using a robot experience fewer skeletomuscular problems of their own in the short and long term than those operating without a robot as an additional tool. This Scientific Impact Paper looks at the use of a robot in different fields of gynaecological surgery. A robot could be considered safe and a more effective surgical tool than conventional keyhole surgery for women who have to undergo complex gynaecology surgery or have associated medical issues such as body-mass index (BMI) at 30 kg/m2 or above or lung problems. The introduction of the use of robots in keyhole surgery has resulted in a decrease in the number of traditional open surgeries and the risk of conversion to open surgery after traditional keyhole surgery; both of which should be considered when examining the cost-benefit of using a robot. Limitations of robotic-assisted surgery remain the associated higher costs. In womb cancer surgery there is good evidence that introducing robotics into the service improves outcomes for women and may reduce costs.

One-stage tubularized urethroplasty using the free inner plate of the foreskin in the treatment of proximal hypospadias

ObjectiveThis study summarizes the short-term efficacy of the one-stage tubularized urethroplasty using the free inner in proximal hypospadias.MethodsA retrospective analysis was conducted on 42 patients with proximal hypospadias. All cases were treated with one-stage tubularized urethroplasty from January 2020 to June 2021. The postoperative complications like urethral fistula, urethral stricture, diverticulum, and split penis head were recorded.ResultsPatients were followed up for 3 to 15 months (an average of 8.5 months). A total of 26 cases (62%) were repaired without any complication. Five patients (11.9%) developed urinary fistulas and underwent secondary repair: three cases with anastomotic fistulas and two cases of coronal fistulas. Nine patients (21.4%) had stenosis of the head segment of the penis, six (14.3%) had stenosis that was relieved by urethral dilatation combined with topical mometasone furoate 1 month after urethral catheter removal. Two patients (4.8%) had severe stenosis with secondary surgical stenosis incision, and one (2.4%) had combined urethral diverticulum in which urethral stenosis incision and diverticulectomy were performed.ConclusionsTubularized urethroplasty using the free inner bears the advantages of easy access, reduced short-term complications, low incidence of diverticula.

Vesicovaginal fistulas: Diagnosis and treatment

Vesicovaginal fistula is an abnormal connection between the vagina and the bladder. The aim of the present study is to reiterate the diagnostic and therapeutic management of vesicovaginal fistulas through a systematic literature review. Pubmed was used as a search machine using as keywords: “vaginal fistula”, “vesicovaginal fistula”, “urogenital fistula” and finally 29 articles were included. As a result of the study, an integrated approach is considered necessary and will best serve the needs of women with vesicovaginal fistula. When a multidisciplinary team approach, consisting of urologists and gynecologists, is used, improvements in quality of life and patient satisfaction can be greater. Although more randomized clinical trials are required in order to compare therapeutic approaches of vesicovaginal fistulas.

Determinants of Duration of Leakage in Women with a Fistula Diagnosis: A Prospective Cohort Study in East African Countries

Introduction: Women living with Vesico Vaginal Fistula (VVF) continue to suffer for many years, and often in silence. Around the world, over 2 million women live with a fistula and new cases continue to be reported especially in low income countries. These countries also tend to have a high maternal morbidity and mortality rates. &#x0D; Objectives: To establish the duration of leakage in a cohort of women diagnosed with fistula. &#x0D; Methodology: A prospective cohort study conducted over a three-year period. Patients with confirmed diagnosis of VVF and or Recto Vaginal fistula (RVF) were eligible for study. A structured questionnaire was used to collect information on sociodemographic profiles, presenting symptoms and duration of leakage. &#x0D; Results: A total of one thousand and twenty-four patients were enrolled in the study, 34% had lived with the fistula for more than 3 years. The majority (70%) were young, with a mean age of 20. Literacy levels were low in this cohort. Urban women were more likely to access fistula care services compared to their rural counterparts (p&gt;0.0001). &#x0D; Conclusion: Individual and country level factors influenced the duration women lived with fistula before surgical repair.

Пузырно-влагалищные свищи: современные концепции диагностики и лечения.

Introduction. Vesicovaginal fistula (VVF) is a pathological communication between the urinary bladder and the vagina. The lack of common approaches to the treatment choice, its timing and postoperative management of patients makes this disorder one of the challenges of modern urogynecology. Materials and methods. Relevant publications were searched using the PubMed database, the Google Scholar search system, and the scientific electronic library eLibrary.ru. Results. VVF is the most common form of urogenital fistulas. In developed countries, the formation of VVF mainly are the result of surgical trauma or radiation therapy, but in developing ones the majority of VVF have an obstetric etiology. There are different classifications of VVF; however, there is no overall accepted one that is suitable for predicting treatment efficacy and long-term outcomes regardless of etiology of VVF. Treatment of VVF with long-term bladder drainage should be performed only for small, benign and unformed VVF. Surgical closure of VVF is the primary method of treatment. Surgery can be performed using abdominal and vaginal access. Regardless of the access, a positive result (closure of the fistula) on average is achieved in 90,8% of cases. The treatment of post-radiation fistulas is more challenged and associated with a high failure rate. Conclusion. Despite of the variety of VVF treatment options, unfortunately, there is no the perfect one yet due to the variability of VVF ethiology, the lack of unified curative approaches and the shortage of studies comparing different therapies.

Evaluation of the Factors Influencing the Use of Contraceptives and Family Planning Methods Among Youths in Calabar Metropolis, Nigeria

Background: The rapid increase in the proportion of sexually active adolescents is exposing large numbers of youths to the risk of unwanted pregnancies and sexually transmitted diseases including HIV/AIDS. This is because the knowledge of contraceptive and family planning methods use in Nigeria is low, resulting in serious reproductive health problems such as unwanted pregnancies, unsafe induced abortion, high rate of vesico - vaginal fistula, (VVF) high maternal mortality rates, sexually transmitted infections (STIs), HIV/AIDS and above all, increase in population in both rural and urban areas. The main thrust of this study was to evaluate the factors influencing the use of contraceptives and family planning methods among youths in Calabar Metropolis of Cross River State, Nigeria. Methods: This was a cross-sectional study. The study population were all youths between the ages of 15-30years in Calabar Metropolis. Non-probability sampling involving purposive and simple random sampling technique were adopted in the selection of two hundred and forty (240) respondents. The data for this study were obtained primarily through the questionnaire and personal interviews. The quantitative and descriptive approaches were adopted. The data were analyzed using frequency tables and percentage distribution. Results: The findings of the study showed that religious barriers, cultural barriers and educational status/level of awareness of the youths greatly influenced their knowledge and use of contraceptives and family planning methods. Conclusion: The study revealed that the adolescents of Calabar Metropolis had knowledge of the use of contraceptives and other family planning methods, but this did not translate to actual practice due to some factors such as religious barriers, cultural barriers as well as their educational status/level of awareness. It was therefore concluded that religious and cultural barriers which impede the use of contraceptives and family planning methods by youths should be modernized to imbibe the concept of proper use of contraceptive to protect them from preventable diseases like HIV/AIDS, sexually transmitted diseases as well as guide against unwanted pregnancies and promote child spacing.

Genitourinary Fistula: A Summary of 18 Years’ Experience in Rajshahi Medical College Hospital, Rajshahi, Bangladesh

Background: Vesico-vaginal fistula is a chronic health condition when abnormal connection between bladder and vagina is seen and causes constant dribbling of urine through vagina. Uretero-vaginal fistula (UVF) defines an abnormal communication between the ureter and vagina which causes urinary incontinence, frequent infection, and discomfort. Methods: This observational longitudinal study was conducted in between 2005- April 2022, at the department of Obstetrics and Gynae in Rajshahi Medical College Hospital, Rajshahi, Bangladesh. The total sample size for this study was 503. Result: Most of the patients 127(25.25%) were between the age of 26-35 years, 125(24.86%) were between the age of 36-45 years, 116(23.06%) were between the age of 46-55 years, 79(15.70%) patients were more than 55 years &amp; remaining 56(11.13%) were between the age of 15-25 years. Regarding the etiology of fistulas, most of the fistulas were following TAH 199(39.56%), 174(34.59%) following obstructed labor, 43(8.55%) following LUCS, 31(6.17%) following corrosive application, 19(3.78%) following malignancy, 18 (3.58%) following Trauma, 8(1.59%) following VH, and others 11(2.18%). Among 503 patients, 423 (84.09%) were Vesico vaginal fistula (VVF), 52 (10.35%) were Rectovaginal fistula (RVF), 21 (4.18%) were Ureterovaginal fistula (UVF), 4 (0.79%) were Vesico uterine fistula and 3 (0.59%) were Vesicocervical fistula. Out of 503 patients, operation was performed in 330 patients. Remaining 173 patients, 95(18.88%) were conservatively treated and 78(15.50%) were referred to higher centre. Repair of fistulas was done in vaginal route 244(74%) and abdominal route were 86(26%). Operation was successful 293(88.79%) and was failed in 37(11.21%). Conclusion: In the past, VVF, UVF and RVF were thought to be the incurable problem but with advanced surgical practice, availability of good suture material and antibiotics it can be cured surgically. There is increased incidence of post-surgical fistula and .......

A simple score for predicting urinary fistula in patients with renal hydatid cysts

ABSTRACT 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.

Ex vivo removal of stones in donor kidneys by pyelotomy prior to renal transplantation: a single-center case series

BackgroundDonors with incidentally discovered asymptomatic renal stones was considered a relative contraindication to the kidney donation because of a potential increased morbidity risk for renal transplant recipients. Stone clearance from the donors should be done before donation to ensure safety of the recipient. This study aimed to observe the safety and efficacy of kidney transplantation from donors with nephrolithiasis who received pyelolithotomy before transplantation.MethodsBetween January 2015 and March 2021, 14 deceased organ donors at The Second Affiliated Hospital of Guangzhou Medical University were found to have kidney stones during predonation evaluation. After donor kidney repair, all of the donor kidneys underwent ex vivo pyelolithotomy. Then the organs were transplanted to the right iliac fossa of 17 patients with end-stage renal failure. Data were analyzed for technical feasibility, intraoperative and postoperative complications, and stone clearance. Ultrasonography and urinal routine were followed at the 1-, 3-, and 6-month postoperatively.ResultsThe stones were successfully removed ex vivo by pyelotomy with an average time of 41.0±12.8 minutes. Seventeen recipients successfully underwent renal transplantation, and their renal function recovered well. Slight gross hematuria occurred in 12 cases after operation, and hematuria disappeared after conservative treatment. Ureteral stents were removed within two months after the procedure. There were no complications such as delayed recovery of renal function, acute rejection, ureteral necrosis, and urinary fistula. The serum creatinine of 17 patients 1 month after the operation was 136.8±26.7 µmol/L. None of the 17 patients included in the study suffered from stone recurrence or graft dysfunction in the follow-up period.ConclusionsEx vivo removal of stones by pyelotomy was a technically feasible means of safely and efficiency rendering a stone-bearing donor kidney stone-free. The procedure obtained good early-middle outcomes in kidney transplantation and is therefore worthy of clinical application.

Three new experimental models of anterior urethral stricture in rabbits.

BackgroundThis study describes and compares three surgical procedures for the construction of urethral stricture (US) models in rabbits.MethodsForty adult male rabbits were allocated to four groups: 36 rabbits were randomly assigned to three experimental groups, while the remaining 4 were assigned to a sham group. The penis was separated from the rectum. Then along the ventral midline, a longitudinal penile skin incision was made while ensuring that the urethral mucosa was intact and the muscular layer was not completely incised. In group 1 (n=12), ventral semi-circumferential mucosa electrocoagulation of a 1-cm length of the anterior urethra was performed until ulceration occurred. In group 2 (n=12), the ventral urethral mucosa was incised, and electrocoagulation of the dorsal semi-circumferential mucosa was performed. In group 3 (n=12), whole-circumferential mucosa electrocoagulation was performed. In group 4 (n=4), no special treatment was performed. Four weeks later, urethrography, urethroscopy, and histological evaluation were carried out.ResultsThe weights of the rabbits in the four groups were comparable. There was no significant difference between groups 2 and 3 with regard to operative time, but the operative time in these groups was significantly longer than that in group 1 (group 2 vs. group 1: P<0.05, group 3 vs. group 1: P<0.001). After the surgery, urinary fistula with infection occurred in one rabbit in group 1, and one rabbit died due to urethral atresia in group 3. According to the urethrography and urethroscopy findings, 9 out of 12 rabbits in group 1, 5 out of 12 rabbits in group 2, and 11 out of 11 rabbits in group 3 developed US, while no rabbits in the sham group developed US. Histopathological examination revealed injury to the urothelium, inflammatory infiltration, a decrease in the amount of blood vessels and smooth muscle fibers, and a decrease in the amount of collagen fibers.ConclusionsCompared with the semi-circumferential procedures, the whole-circumferential procedure had a higher success rate. Therefore, this procedure seems to have potential for the construction of long-segment rabbit US models.

Abstract No. 573 Embolization of urinary tract fistulae using an Amplatzer vascular plug and glue

To determine the efficacy of Amplatzer Vascular Plug (AVP) and glue in the treatment of urinary tract fistulas