INTRODUCTION:In developed countries, urologic fistulas arise mainly from malignancies, radiotherapy, or surgical trauma. Hysterectomy and radiation therapy are both critical components of the treatment of women with cancers. Urologic fistulas significantly reduce the quality of life of cancer patients, and may result in delays or even refusal of adjuvant treatment by these patients, thereby negatively impacting both short- and long-term cancer survival. MATERIALS AND METHODS:A 10-year retrospective study of urologic fistulas associated with gynaecologic malignancies at the University hospital Hradec Kralove, Czech Republic was conducted. Descriptive statistics of the fistula and treatment characteristics of women with malignant fistulas were conducted using the NCSS 22 statistical software program (NCSS, Keysville, Utah). RESULTS:Cervical cancer was mostly commonly associated with urologic fistulas (36, 76.8%). Most of the malignant fistulas were complex (41, 87.2%) vesicovaginal (23, 48.9%) fistulas (VVFs). More than two-thirds (33, 70.2%) of the fistulas were diagnosed following radiotherapy, with a time interval from radiotherapy to fistula diagnosis of between 3.00 and 14.50 years. Primary fistuloraphy was performed for all the six cases with simple VVFs and seven (41.2%) of the 17 patients with complex VVFs. Treatment success rate was 83.33% and 14.3% for simple and complex fistulas, respectively. All the failed complex fistula repairs recurred. CONCLUSION:Malignant fistulas predominantly follow radiotherapy for cervical cancers, and are usually detected up to 15 years post-radiotherapy. Most are complex VVFs, which are difficult to treat, with a high rate of recurrence.

Inflammatory myofibroblastic tumors (IMTs) of the bladder are rare, with a limited number of cases reported in the literature. Complete resection with negative margins is essential to reduce the risk of recurrence, while bladder function preservation is also crucial for the patient. This study describes a 56-year-old patient with a bladder dome IMT managed using robot-assisted partial cystectomy facili- tated by perioperative cystoscopic tattooing to precisely demarcate the tumor margins. The procedure began with cystoscopic tattooing of the lesion using Black Eye dye, followed by robotic resection with the da Vinci Xi system. Complete transmural resection and a 2-layer bladder closure were performed, with preservation of the bladder capacity. The patient experienced minimal blood loss, no intraopera- tive complications, and was discharged 2 days after the procedure. Follow-up examinations, including cystoscopy and computed tomography, confirmed no recurrence 12 months after surgery. Cystoscopic tattooing facilitated clear intraoperative tumor localization, enabling precise resection and minimal bladder wall loss. This approach addressed a key challenge of robotic bladder surgery-lack of tactile feedback-while maintaining functional outcomes. Robot-assisted partial cystectomy with cystoscopic tattooing represents a promising alternative to maximal transurethral resection, especially in the context of bladder-sparing trimodal therapy, for patients who are not eligible for or unwilling to undergo radical cystectomy. This technique is particularly relevant given the increasing focus on minimally invasive procedures and advancements in systemic therapy. In the future, this method could be adapted for ureteral robotic surgeries to enhance lesion localization.

INTRODUCTION:The genitourinary tract and retroperitoneal hemorrhage belong to severe and sometimes life-threatening urological emergencies. Interventional radiology methods can significantly reduce morbidity and mortality in patients who fail conservative treatment and are unfit for surgery. MATERIALS:We performed a retrospective analysis of patients indicated for angiography and vasographic intervention due to urological pathology in 2015-2020. The study focused on the etiology, technical, clinical success, and possible complications related to angioembolization. RESULTS:In 5 years, we recorded 51 patients who underwent angiography to localize arterial bleeding or diagnose arteriovenous malformation. In 46 patients (90%), the interventional radiologist subsequently embolized active bleeding or selectively obliterated the main branches of the artery. Angiography did not show extravasation in five patients. Therefore, embolization was not performed. The radiologist assessed the technical success of embolization as 100% in all cases. Two patients experienced a recurrence of bleeding between 24 and 72 hours after the procedure, and the vasography had to be repeated. The predominant finding was hematuria in more than 75% of cases, followed by retroperitoneal hematoma, including perirenal hematoma. Twenty-four embolizations were performed in the renal artery basin; internal pelvic arteries were embolized or obliterated in 21 cases. In one case, a urologist indicated vasography of the left bulbar artery of the penis due to high-pressure priapism. CONCLUSION:Vasographic embolization remains an important treatment option in case of hemodynamically significant hemorrhage. Our data support the importance of angioembolization in cases of severe bleeding in the urinary tract with good patient tolerability.

Inflammatory myofibroblastic tumors (IMTs) of the bladder are rare, with a limited number of cases reported in the literature. Complete resection with negative margins is essential to reduce the risk of recurrence, while bladder function preservation is also crucial for the patient. This study describes a 56‑year‑old patient with a bladder dome IMT managed using robot‑assisted partial cystectomy facili‑ tated by perioperative cystoscopic tattooing to precisely demarcate the tumor margins. The procedure began with cystoscopic tattooing of the lesion using Black Eye dye, followed by robotic resection with the da Vinci Xi system. Complete transmural resection and a 2‑layer bladder closure were performed, with preservation of the bladder capacity. The patient experienced minimal blood loss, no intraopera‑ tive complications, and was discharged 2 days after the procedure. Follow‑up examinations, including cystoscopy and computed tomography, confirmed no recurrence 12 months after surgery. Cystoscopic tattooing facilitated clear intraoperative tumor localization, enabling precise resection and minimal bladder wall loss. This approach addressed a key challenge of robotic bladder surgery-lack of tactile feedback-while maintaining functional outcomes. Robot‑assisted partial cystectomy with cystoscopic tattooing represents a promising alternative to maximal transurethral resection, especially in the context of bladder‑sparing trimodal therapy, for patients who are not eligible for or unwilling to undergo radical cystectomy. This technique is particularly relevant given the increasing focus on minimally invasive procedures and advancements in systemic therapy. In the future, this method could be adapted for ureteral robotic surgeries to enhance lesion localization.

BACKGROUND:Renal cell carcinoma (RCC) is a prevalent kidney malignancy known for its aggressive nature and potential to extend into the renal vein or inferior vena cava (IVC), affecting patient prognosis and treatment strategies. OBJECTIVE:To assess the long-term outcomes and effectiveness of radical nephrectomy with IVC thrombectomy in patients with RCC presenting with level I-IV IVC thrombus. METHODS:A retrospective analysis was conducted on 164 adult patients treated for RCC with IVC thrombectomy at a tertiary care center from January 2004 to December 2023. Data including demographics, clinical characteristics, tumor specifics, surgical details, complications, and survival rates were meticulously reviewed. RESULTS:Among the patients, the mean age was 63.7 years, predominantly male (69.5%). The histological profile showed a majority of clear cell carcinoma (95.7%), with most tumors located on the right side (71.3%). Thrombus levels were distributed across I-IV, with 41 (25%) patients presenting with level I, 33 (20.1%) with level II, 55 (33.5%) with level III, and 35 (21.4%) with level IV thrombi. The mean operation time and blood loss increased with thrombus level. Perioperative complications were recorded in 57.3% of patients, and over half of the patients experienced disease recurrence (54.9%). The overall 5-year survival rate stood at 42.1%, with notably better survival in patients with level I thrombi. CONCLUSION:Radical nephrectomy with IVC thrombectomy provides a potential for long-term control in patients with RCC and IVC thrombus, although it is associated with significant morbidity. Multidisciplinary care and expert surgical intervention are crucial for improving patient outcomes. The variability in survival rates across thrombus levels underscores the need for individualized treatment approaches.

INTRODUCTION:This study examines the efficacy of prophylactic mesh implantation during open radical cystectomy with ileal conduit diversion in preventing parastomal hernias (PH). Despite PH being a common complication, prophylactic methods have been underexplored. METHODS:A pilot, single-center, prospective cohort study was conducted involving five patients undergoing surgery with mesh implantation. Demographic and clinical characteristics were monitored, including the incidence of PH, operation time, blood loss, and hospitalization duration. RESULTS:During the mean follow-up period of 9.1±3.2 months post-operation, no occurrences of PH were observed in the patient group. Despite the risks associated with implanting foreign material in an area of surgery involving open small intestine, no infectious complications were noted. CONCLUSION:Prophylactic mesh implantation in radical cystectomy with ileal conduit diversion appears to be an effective preventive measure against PH. Further extensive studies are required to definitively confirm the efficacy and safety of mesh use in this context.

AIM:A retrospective audit from a urological center focused on urological fistulas that directly connect with the treatment of gynecological malignancy. Ureteroarterial fistulas, i.e., pathological communication between the ureter and the artery, are discussed in more detail. MATERIALS AND METHODS:Over a period of ten years, from 2011 to 2020, a group of 47 patients with a diagnosis of urinary fistula was retrospectively evaluated. These patients, with a history of treatment for gynecological malignancy, were sent to our clinic from local and non-regional departments in the Czech Republic. We found three cases of ureteroarterial fistula in the presented analysis that focused on urological toxicity of oncogynecological treatment. RESULTS:Within the mentioned period of ten years, we recorded 64 cases of urinary fistulas, and 47 patients (73.4%) were directly related to oncogynecological treatment. In the group with gynecological tumors, we found three patients (6.4%) with a diagnosis of ureteroarterial fistula, two of whom died directly related to this complication (exsanguination). These patients were treated for cervical cancer. All of them underwent radiotherapy during the treatment. CONCLUSION:Ureteroarterial fistulas are the most severe complications that can occur in medicine. This work confirms that we have encountered these cases even recently. Management is highly demanding for patients affected in this way and requires multidisciplinary cooperation. Endovascular intervention methods can control bleeding in emergency situations with non-surgical approaches. However, they are usually the first step towards a definitive surgical solution.

Background Renal cell carcinoma (RCC) with tumor thrombus extension into the right atrium (level IV) is a rare life-threatening clinical condition that can only be managed by means of a combined urological and cardiac surgical approach. The early and late outcomes of this radical treatment were analyzed in a large single-institution series over a period of 30 years. Methods In 37 patients with RCC and intracardiac tumor thrombus extension, nephrectomy was performed followed by the extraction of the intracaval and intracardiac tumor thrombus under direct visual control during deep hypothermic circulatory arrest (DHCA). Recently, in 13 patients, selective aortic arch perfusion (SAAP) was instituted during DHCA. Results In all patients, precise removal of the tumor thrombus was accomplished in a bloodless field. The mean duration of isolated DHCA was 15 ± 6 min, and 31.5 ± 10.2 min in the case of DHCA + SAAP, at a mean hypothermia of 22.7 ± 4°C. In-hospital mortality was 7.9% (3 patients). In Kaplan–Meier analysis, the estimated median survival was 26.4 months whereas the 5-year cancer-related survival rate was 51%. Conclusions Despite its complexity, this extensive procedure can be performed safely with a generally uneventful postoperative course. The use of cardiopulmonary bypass with DHCA, with the advantage of SAAP, allows for a safe, precise, and complete extirpation of intracaval and intracardiac tumor mass. Late outcomes after radical surgical treatment in patients with RCC and tumor thrombus reaching up in the right atrium in our series justify this extensive procedure.

The prophylactic administration of tranexamic acid reduces blood loss during procedures at high risk of perioperative bleeding. Several studies in cardiac surgery and orthopedics confirmed this finding. The aim of this prospective, double-blind, randomized study is to evaluate the effect of tranexamic acid on peri-and postoperative blood loss and on the incidence and severity of complications. Based on the results of our pilot study, we decided to conduct this prospective, double-blind, randomized trial to confirm the preliminary data. The primary endpoint is to analyze the effect of tranexamic acid on perioperative and postoperative blood loss (decrease in hemoglobin levels) in robotic-assisted radical prostatectomy. The additional endpoint is to analyze the effect of tranexamic acid on postoperative complications and confirm the safety of tranexamic acid in robotic-assisted radical prostatectomy. No study to date has tested the prophylactic administration of tranexamic acid at the beginning of robotic-assisted radical prostatectomy. This study is designed to answer the question of whether the administration of tranexamic acid might lower the blood loss after the procedure or increase the rate and severity of complications. ClinicalTrials.gov NCT04319614. Registered on 25 March 2020

Ochratoxin A (OTA) exposure can result in chronic renal diseases and cancer. The incidence of kidney, renal pelvis, and ureter malignant neoplasms in the Czech Republic is approximately 29.5 renal tumours per 100,000 inhabitants. The question arises whether mycotoxins are also involved in kidney disease and cancer. A sensitive validated analytical methodology, based on an immunoaffinity clean-up followed by HPLC with fluorescence detection, was developed to explore whether OTA accumulates in clear renal cell carcinoma-adenocarcinoma in Czech patients. Simultaneously, DNA-adducts and OTA metabolites were qualitatively analysed in tissues and urine. OTA was analysed in 33 kidney and tumour samples from 26 men and 7 women collected during nephrectomy from patients of the East Bohemian region from 2015 to 2017. OTA was found in 76% of the analysed samples. Its concentrations ranged from not detectable to 390 ng/kg with a median of 167 ng/kg in kidney samples and from not detectable to 430 ng/kg with a median of 122 ng/kg in tumour samples. Urinary OTA metabolites and DNA adducts were qualitatively analysed for the corresponding 20 patients. The presence of some OTA metabolites such as ochratoxin A hydroquinone and/or decarboxylated ochratoxin A hydroquinone correlate with the presence of OTA-DNA adducts.

Cíl: BCG (Bacillus Calmette-Guérin) je oslabené mykobakterium původně vyvinuté jako vakcinace proti tuberkulóze. Při intravezikální aplikaci této vakcíny byl prokázán protinádorový efekt se signifikantním snížením pravděpodobnosti progrese onemocnění u pacientů s high grade NMIBC (Non Muscle Invasive Bladder Cancer) a CIS (Carcimoma In Situ) po kompletní endoresekci tumoru (TURT). Cílem naší práce bylo zhodnotit soubor 82 pacientů, kteří na našem pracovišti podstoupili léčbu BCG vakcínou v letech 2001–2017. Metoda: Bylo retrospektivně hodnoceno: věk, pohlaví, životní styl (kouření), velikost tumoru, přítomnost či nepřítomnost CIS, EORT skóre rekurence a progrese. Pacienti byli rozděleni do skupiny BCG úspěch a BCG selhání. Do skupiny BCG selhání byli zařazeni pacienti s recidivou high grade tumoru a CIS či s progresí do MIBC nebo dokonce zemřelí na karcinom močového měchýře během sledování. Výsledky: Doba sledování pacientů byla od 2 do 13 roků. Úspěch BCG léčby byl pozorován u 68 % pacientů, selhání BCG léčby bylo u 32 % pacientů. Ve skupině selhání se jednalo o rekurenci onemocnění u 23 % pacientů a progresi onemocnění u 9 % pacientů. 5 % pacientů zemřelo na karcinom močového měchýře. Průměrná doba do selhání BCG terapie byla deset měsíců. Závěr: V našem souboru pacientů byl potvrzen dobrý klinický efekt BCG instilační terapie u pacientů high grade NMIBC a CIS močového měchýře s minimálním výskytem komplikací. Klíčová slova: BCG, karcinom močového měchýře, CIS.