Rishi Nayyar

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Objectives: To present our experience and outcomes in the surgical management of rectourethral fistula (RUF). Materials and methods: We retrospectively analysed data from 11 patients treated for RUF between 2015 and 2024. Patient demographics, aetiology, fistula complexity, surgical approach, and outcomes were reviewed. Results: The mean patient age was 29 years (range = 18–62). In 81% of cases, RUF resulted from road traffic accidents, and four patients had previously failed repairs. All patients underwent suprapubic catheter placement and faecal diversion before definitive surgery. Seven patients (63.6%) had a complex fistulas, while four had simple ones. The perineal approach was used in eight patients (72.7%), with a transpubic in two patients (18.18%) and cystectomy with ileal conduit diversion in one patient (9%). The gracilis muscle interposition flap was used in most cases. At a 1-year follow-up, no patients experienced per rectal leakage, and 81% had catheter removal by 3 months. Conclusion: Our study demonstrates that with thorough evaluation and proper management, RUF closure rates can reach up to 100%. The pedicled gracilis muscle flap is highly effective for interposition in complex cases. Level of evidence: 2c

Two complex small renal masses were operated using a novel method of utilising indocyanine green fluorescence for nephron-sparing surgery (NSS), overcoming its current limitations of short duration of effect and non-enhancement of the tumor. The dye was emulsified with ethiodized oil and a 1:1 mixture was administered on the morning of the surgery using superselective cannulation of the direct tumoral blood supply. The fluorescence could be used throughout the entire course of the surgery irrespective of arterial clamping, allowing quick tumor identification, edge marking, and near-enucleation over enucleoresection. This novel method has the potential to aid the surgeon during various critical steps of NSS.

Urethral duplication is a rare congenital anomaly characterized by more than one urethral channel, with varied course, location of the external opening, and presentation. Presentations can be varied, depending upon individual anatomical dispensation but mostly present as obstruction, recurrent urinary infection, or double urinary stream. Treatment depends on the type of duplication and associated anomalies. Here, we report a case of urethral duplication which did not fit into any known reported type of urethral duplication forms and had five openings at the anal verge.

The evidence on bladder cancer in the young population remains fragmented due to lack of literature and conflicting results from the existing studies. We aim to elucidate such conflicting data and define the clinicopathologic characteristics, management trends, and outcomes of urothelial bladder carcinoma in young adults as compared to their older counterparts. This was a retrospective, single-center study involving patients with primary urothelial bladder cancer who underwent treatment at our center from March 2017 to March 2022. For analysis, patients were stratified into three subgroups based on age: group A, 18–40 years; group B, > 40 years; and group C, > 60 years. Group A with younger patients was compared with groups B and C. A total of 471 eligible patients (422 males and 49 females) were included in the study with a median age of 44 years. Group A had significantly lower recurrence and progression rates as compared to group B (31% vs 57.1%, p = 0.002 and 9.5% vs 19.2%, p = 0.04, respectively). Group A had significantly more recurrence-free survival (RFS) than group B (5-year-RFS = 68.03% vs 32.58%, p = 0.01). Similarly, group A also had lower recurrence (31% vs 62.6%, p < 0.001) and progression (9.5% vs 28.6%, p = 0.015) rates as compared to group C as well as better RFS (5-year-RFS = 68.03% vs 19.00%, p = 0.04) and progression-free survival (5-year-PFS = 83.1% vs 62.8%, p = 0.03) in comparison to group C. Age and tumor grade were found to be independent predictors of recurrence-free and progression-free survival. We concluded that high-grade disease is more common than low-grade disease both in younger and older patients. Younger patients fare better in terms of recurrence and progression when compared to their older counterparts.