Uterovesical fistulas as obstetric complications: Diagnosis, management and prognosis (Review).

Urogenital fistulas are abnormal communications between the female genital and urinary tract; while such fistulas, which are the most commonly encountered, are located between the vagina and urinary bladder and are caused by the local extension of a tumoral process. Another frequently encountered cause is represented by the obstetric one, leading to the development of uterovesical fistulas. However, many questions regarding the diagnosis and management of uterovesical fistulas remain unanswered. Therefore, the aim of this article was to review the existent data so far, with special attention being focused on the pathogenic mechanisms leading to this complication, on the modalities of diagnosis, and on the possible therapeutic strategies. Therefore, according to the time of diagnosis, uterovesical fistulas can be classified as early fistulas, diagnosed in the first months postoperatively and late fistulas, diagnosed within several years from the initial surgical procedure. For early fistulas, a conservative therapeutic strategy can be taken in consideration, while in cases diagnosed after a longer period of time, a surgical approach should be taken into consideration. Meanwhile, although a surgical approach can cure most of the cases, attention should be given towards preventive strategies such as provision of quality obstetric care with improvements of surgical skills.

Vascular Resections in Association With Pancreatic Resections for Locally Advanced Pancreatic Cancer.

BACKGROUND/AIM: Locally advanced pancreatic cancer has been considered for a long period of time as an unresectable lesion and therefore, all patients have been traditionally addressed to the oncological services for palliative purposes. However, due to the wide usage of newer oncological agents in association with improved surgical techniques, radical surgical procedures became feasible. The aim of this study was to present the different surgical procedures that were performed in locally advanced pancreatic cancer patients in order to achieve radical resections. PATIENTS AND METHODS: Between 2019 and 2020, six cases were submitted to pancreatic and vascular resections in Fundeni Clinical Hospital. RESULTS: In all cases, surgery with curative intent was attempted; portal vein resection was performed in five cases, whereas arterial resection was performed in three cases. Reconstruction was performed by direct re-anastomosis, by placing cadaveric or synthetic grafts. The postoperative outcomes were favourable in all cases. CONCLUSION: Vascular resections can be safely associated with pancreatic resections in cases presenting locally advanced pancreatic lesions, with acceptable morbidity rates.

Major Hepatectomy En Bloc with Cava Vein Resection for Locally Invasive Caudate Lobe Hepatocarcinoma.

BACKGROUND/AIM: Locally advanced liver tumours with vascular invasion have been considered for a long period of time as unresectable lesions, so the patient was further deferred to oncology services for palliation. However, improvement of the surgical techniques and the results reported so far came to demonstrate that extended hepatic and vascular resections might be safely performed in such cases and might significantly improve the long-term outcomes. MATERIALS AND METHODS: A 61-year-old patient was diagnosed with a caudate lobe tumour invading the inferior cava vein and the right hepatic pedicle. RESULTS: The patient was successfully submitted to surgery, and an extended right hepatectomy en bloc with cava vein resection was performed; the continuity of the cava vein was re-established by the placement of a synthetic graft. The postoperative outcome was uneventful. CONCLUSIONS: Although initially considered as a formal contraindication for resection, vascular invasion of the greater vessels should not preclude surgery if complete resection is achievable.