[Surgical treatment of vesicovaginal fistulas].

To improve surgical outcomes in patients with complicated recurrent, radiation-induced, giant and multiple vesicovaginal fistulas, we have developed a new combined method of fistuloplasty (patent 21350999). The method was used in 12 of 32 operations made in 1997-2007 in the urological clinic of the Kazan Medical University for vesicovaginal fistula in patients aged 19 to 72 years. The technique was applied in women with vesicovaginal fistula located close to the ureteral orifice. Good results of the operation were achieved due to leak-proof sutures, accurate dissection of the bladder from the vagina and intact blood supply of the tissues. Two surgical approaches were used: transvesical and vaginal. Neither complications nor relapses occurred in all 12 patients operated by the proposed technique of combined fistuloplasty which proved to be effective in recurrent, complicated, combined fistulas and is a method of choice in complicated, recurrent, radiation-induced, giant and multiple fistulas.

[Autotransplantation of the kidney in ureteral injuries].

In 1988-2003 we operated 156 patients with various ureteral lesions. Of them 7 patients (6 males and 1 female, mean age 34-43 years) received kidney transplant (autotransplantation). Ureteral lesions were caused by previous surgery (n=3), gunshot wound (n=2), urolithiasis (n=2. The follow-up results (for 15 period maximum) show that operative outcomes were satisfactory in 6 patients. One transplant was removed 7 days after the transplantation because of purulent pyelonephritis and necrosis of the ureter. The rest patients retain good function of the transplanted kidney and passability of the upper urinary tract. Thus, surgical autotransplantation of the kidney performed in affected middle and low thirds of the ureter is an alternative to life-long nephrostomy and nephrectomy and has a good long-term prognosis in relation to function of a transplanted kidney.