Bladder stone causing vesicovaginal fistula and migration into the vagina.

Bladder stone is a known complication in a neurogenic bladder that can very rarely cause vesicovaginal fistula (VVF). We are presenting the case of a woman in her late 70s, bed bound with progressive multiple sclerosis (MS), who was referred to urology for consideration of suprapubic catheter due to difficulty in managing her indwelling urethral catheter. The ultrasonogram (USG) identified a 4.7 cm bladder stone with right-sided hydronephrosis (HN) and left atrophic kidney. A CT scan later showed that a 5 cm bladder stone has migrated through a VVF into her vagina. She had a cystoscopy and transvaginal retrieval of the stone. Given her performance status and intraoperative finding of a small contracted bladder, it was agreed to manage her VVF conservatively.To the best of our knowledge, this is the first case of a primary bladder stone migrating into the vagina through a VVF.

Vascular injuries during laparoscopic donor nephrectomy and proposed risk reduction strategies

ABSTRACT Introduction: Laparoscopic donor nephrectomy (LDN) has become the standard of care and popular among most of the transplant centres across the globe. Objective of this video is to report different vascular injuries, their management during LDNs and propose risk reduction strategies. Patient and methods: This was a retrospective analysis of all the LDNs performed between January 2011 and March 2016. All donor nephrectomies were performed laparoscopically by transperitoneal route, under ideal operative conditions by expert laparoscopic surgeons and by novice surgeons. Results: 858 LDNs (left, n = 797; right, n = 61) were performed during the study period with 5 cases of vascular injuries. Mean (SD) donor age was 45.5 (± 10.76) years and the operative time was 165 (± 44.4) min. Of these five cases, two had renal vein injury, while the three others had renal artery, inferior vena cava and aortic injury (one each). Four injuries occurred during left LDN and only one during a right LDN. Vascular injuries were managed using the Rescue stitch or metallic clips as indicated. Risk reduction strategy was developed to avoid vascular injuries during LDN, which include - meticulous attention to port placement, addition of fourth port, complete dissection of upper pole and pedicle before clipping, and judicious use of ultrasonic diathermy. Conclusions: Careful evaluation of computed tomography angiography just before surgery will act like a global positioning system (GPS) for the operating surgeon. Rescue stitch is a saviour. Not to panic and being well versed with the risk reduction strategies of laparoscopy and rescue measures is of paramount importance.

Vascular injuries during laparoscopic donor nephrectomy and proposed risk reduction strategies.

INTRODUCTION: Laparoscopic donor nephrectomy (LDN) has become the standard of care and popular among most of the transplant centres across the globe. Objective of this video is to report different vascular injuries, their management during LDNs and propose risk reduction strategies. PATIENT AND METHODS: This was a retrospective analysis of all the LDNs performed between January 2011 and March 2016. All donor nephrectomies were performed laparoscopically by transperitoneal route, under ideal operative conditions by expert laparoscopic surgeons and by novice surgeons. RESULTS: 858 LDNs (left, n = 797; right, n = 61) were performed during the study period with 5 cases of vascular injuries. Mean (SD) donor age was 45.5 (± 10.76) years and the operative time was 165 (± 44.4) min. Of these five cases, two had renal vein injury, while the three others had renal artery, inferior vena cava and aortic injury (one each). Four injuries occurred during left LDN and only one during a right LDN. Vascular injuries were managed using the Rescue stitch or metallic clips as indicated. Risk reduction strategy was developed to avoid vascular injuries during LDN, which include - meticulous attention to port placement, addition of fourth port, complete dissection of upper pole and pedicle before clipping, and judicious use of ultrasonic diathermy. CONCLUSIONS: Careful evaluation of computed tomography angiography just before surgery will act like a global positioning system (GPS) for the operating surgeon. Rescue stitch is a saviour. Not to panic and being well versed with the risk reduction strategies of laparoscopy and rescue measures is of paramount importance.

Robotic buccal mucosa graft ureteroplasty (inlay and onlay) for upper ureteric stricture: Point of technique.

Ureteral stricture resulting from chronic inflammations such as tuberculosis, recurrent stone disease and multiple endourological interventions are complex in nature; these may lead to severe adhesions to surrounding structures. Endourological management of these cases is difficult with poorer outcomes. In such situations, reconstructive surgical corrections remain a reliable option. We describe the technique of onlay and inlay buccal mucosal graft ureteroplasty using a robotic platform in management of complex ureteral strictures.