Background This study aims to present long-term results, preoperative classification, and surgical approach in the therapy of vesicovaginal fistulas (VVF) and neovesicovaginal fistulas (NVVF). Unlike developing countries, where fistulas are mainly the result of delivery trauma, in the modern world, the main causes are urogynecological surgery and irradiation therapy. Methods Data of 36 woman who underwent surgical treatment of VVF and NVVF were collected retrospectively. After clinical assessment, fistulas were categorized by the Goh classification system, which led to the choice of surgical approach: transvaginal or transabdominal. Follow-up period was 60 to 108 months. Results Out of 36 patients evaluated, 23 were operated transabdominal, and 13 were operated transvaginal. Patients selected for the transabdominal approach were mainly categorized as Goh 1 and 2, including patients after radiotherapy and patients with large fistulas. Patients selected for the transvaginal approach were mainly Goh 3 and 4. There were no statistical differences between groups regarding the success of the operation (83.3%) and complication rate. Complications included fistula recurrence (16.6%), stress urinary incontinence (22.2%), urinary tract infections (11.1%), overactive bladder (13.9%), and urosepsis (2.8%). There was a statistical difference in the duration of the hospital stay in favor of the transvaginal approach (12.00 ± 5.8 vs 16.27 ± 4.65). Conclusions Success in the surgical treatment of VVF and NVVF can be achieved by careful preoperative classification, selection of surgical approach, assessment of local tissue status, taking into consideration the characteristics of the fistulas, and adhering to the basic surgical principles. Regardless of the surgical approach, conducting such a preoperative stratification can achieve similar long-term outcomes. Most fistula recurrence (83.3%) appeared within 6 months after the surgery.

SUMMARY – Infections are well-known complications of radical prostatectomy. In the United States and Europe, the rates of surgical site infections are generally less than 1% and of other infections up to 3%. We report a case of a 62-year-old man who developed severe sepsis with renal insufficiency, paralytic ileus and polyserositis after radical prostatectomy, as a consequence of probable quinolone-resistant bacterial infection. Computed tomography of the abdomen and chest showed polyserositis with bilateral pleural and peritoneal effusions. Treatment with meropenem and other supportive measures resulted in good clinical outcome. This case suggested that severe sepsis with exudative polyserositis was probably caused by mobilization of an infective agent (bacterium) during bladder neck dissection as part of open radical prostatectomy.

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Background A case of simultaneous adrenocortical and renal cell carcinoma due to long-term lead exposure from residual gun pellets is a rare and relatively unknown topic in the literature. Case presentation We present a 43-year-old male patient with a giant retroperitoneal tumor. Thirteen years before he had a shotgun injury of the left upper side of the abdomen and residual gun pellets are present in the abdominal wall. Extirpation of the tumor and the left kidney was performed. Histopathological examination described adrenocortical and renal cell carcinoma. Conclusion Continuous and long-term exposure to toxic lead effects from residual gun pellets and traumatic injury represent likely carcinogenic factors in the presented patient.