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Objective: To conduct a systematic review of the literature on vesicovaginal fistula (VVF), including reporting on the aetiology, in both developed and underdeveloped countries; diagnosis; intraoperative prevention; and management. Methods: We conducted a systematic review of the literature on VVF through the PubMed and the Cochrane Library according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The search was conducted from 1985 to 2018 in English, using the keywords 'fistula' and 'vesicovaginal fistula'. Prospective studies were preferred; however, retrospective studies and case reports were used when no prospective studies were available. All authors' extracted relevant data related to the proposed review of VVF and carefully examined collected articles. Results: In all, 116 relevant articles were identified and 43 articles were included in this systematic review. The outcome of surgical reconstruction was >90%, but the outcome may be suboptimal in radiotherapy (RT)-induced VVFs. Absolute indications for an abdominal approach included: ureteric involvement, the need for concomitant bladder augmentation, severe vaginal stenosis, and an inability to tolerate the dorsal lithotomy position (e.g. due to muscular spasticity). Typically, it was recommended to wait at least 3 months to allow the inflammatory response to subside before definitive surgery. Early fistula repair can be performed in the absence of infection and in patients who have not received pelvic RT. Conclusion: VVF is rare in developed countries. Surgical treatment is the primary method of repair. The outcome of surgical reconstruction exceeds 90%, but the outcome may be suboptimal in RT-induced VVFs.

Objective: The aim of this work is the presentation of a case of isolated renal hydatid cyst with novel findings and an unusual surgical scenario. Clinical Presentation and Intervention: A 54-year-old female patient presented with left loin pain and a palpable left renal mass. Imaging described a well-demarcated left renal cystic lesion with a double-layer wall. Radical nephrectomy was performed due to the possibility of malignancy. On retrograde revision, the double-layer wall represented the detached germinative membrane of a hydatid cyst that was confirmed by histopathology. Conclusion: Isolated renal hydatid cyst could be misinterpreted as a renal tumor. It should be considered in the differential diagnosis of renal cystic lesions.

Background: Ureteral catheters are valuable indispensable devices may readily acquire biofilms on the inner or outer surfaces. This study evaluated the efficacies of ureteral catheters impregnated with ciprofloxacin, N-acetylcysteine each alone and in combination on microbial adherence.Methods: Antimicrobial durability of ureteral catheters coated, through instant dip method, with ciprofloxacin were determined using modified Kirby-Bauer method. Ciprofloxacin-coated catheters showed zones of inhibition ranged from 15 to 45 mm in diameter (baseline) against nine clinical strains recently isolated from patients undergoing ureteral stent removal. Segments coated with ciprofloxacin, N-acetylcysteine each alone and in combination, through instant dip method, were incubated with the tested microorganisms, washed, sonicated, cultured and the number of viable cells were determined.Results: Ciprofloxacin-coated catheters soaked in urine and incubated at 37 °C, maintained antimicrobial activities and produce zones of inhibition that measured 2-10 mm for at least 8 weeks. Effect of ciprofloxacin and N-acetylcysteine coated catheters on microbial adherence were found to be dose dependent. Catheters impregnated with ciprofloxacin/N-acetylcysteine showed the highest inhibitory effect on microbial adherence when compared with controls (85.5%-100%).Conclusion: Catheters impregnated with ciprofloxacin, using instant dip method, were shown to have broad spectrum, prolonged antimicrobial durability and high efficacy. On the other hand, Catheters impregnated with ciprofloxacin/NAC showed the highest inhibitory effect on microbial adherence to stent surfaces.

Background: Staphylococci are a common cause of catheter-associated urinary tract infections. The present study evaluated biofilm forming capacity and the presence of both icaA and icaD genes among staphylococci strains isolated from patients undergoing ureteral catheterization. Methodology: Different bacterial strains were isolated from urine and stents segments collected from 100 patients. Strains were identified by traditional microbiological methods. Stents were examined for biofilm using a scanning electron microscope (SEM). Staphylococcal isolates were tested for their ability to produce biofilm using the tissue culture plate assay method (TCP). The presence of icaA and icaD genes was determined by PCR technique. Results: Fifty-three staphylococcal strains were isolated and identified from 284 samples (18.7%). Forty-six staphylococcal strains were isolated from stent segment cultures while only seven strains were isolated from urine samples at the day of stent removal. S. aureus represented 6.3%, and S. epidermidis represented 12.3%. Out of the 18 S. aureus strains, 15 (83.3%) were biofilm producers and out of 35 S. epidermidis strains, 31 (88.6%) were biofilm producers. Staphylococcal strains were further classified as high (56.6%), moderate (30.2%) and non biofilm producers (13.2%). All biofilm producing strains were positive for icaA and icaD genes, and all biofilm negative strains were negative for both genes. Conclusion: Staphylococci isolated from catheter segments showed a higher extent of biofilm production than that isolated from urine samples. All biofilm producing staphylococci were positive for icaA and icaD genes, which indicates the important role of ica genes as virulence markers in staphylococcal infections associated with urinary catheterization.