Persistent perineal sinus is a common complication after perineal surgeries reporting upto 30% in various series. Most common underlying cause is wound infection, lymphocele, incomplete healing due to irradiated tissue etc. Iatrogenic urethral injury leading to urethro-cutaneous fistula is a rarely reported cause of perineal sinus. Most of the cases of perineal sinuses are usually neglected, considering them for spontaneous healing. Here we have reported a case incorporating the clinical presentation, diagnostic difficulty and a minimal invasive modality for successful management of this distressing condition.

Objective: To investigate the effectiveness and safety of Bilateral Same-Session Ureteroscopy (BSU) for urolithiasis in the contemporary endourology.

Material and Methods: Patients over 18 years old with bilateral urolithiasis in the upper urinary tract were selected under following criteria: total stone burden ≤40mm (accumulated diameter); size of single stone ≤20mm in the major burden side and ≤15mm in the minor; preoperative Serum Creatinine (sCr) normal. Patients were grouped into low burden (<20mm) and high burden (≥20mm) by overall stone burden. Parameters of operation and follow up were evaluated and compared.

Results: 32 cases (male19, female13; age 53.2±14.2yrs) were included from Jan 2013 to Dec 2014.Overall stone burden was 23.7±7.6 (14-40) mm, total stone number 109 (renal 78, ureteral 31). Operative time was 99.2±32.5 (50-175) mins, postoperative hospitalization 2.4±1.4 (1-6) days. Staged procedure took place in two cases. The immediate SFRs after first procedure and overall were 72.0% and 91.0%. However, the immediate SFRs in low burden and high burden were 100% and 50.0% (P=0.002) respectively. No significant sCr change was detected (p=0.711) and no major complications occurred.

Conclusions: BSU for selective cases with bilateral urolithiasis in the upper urinary could be redefined at contemporary endourology. From our study, it is effective and safe with high SFRs, no renal damage and minimal complications. Patients with low bilateral burden (<20mm) may benefit from the immediate stone clearance.

Invasive urodynamics are used to diagnose complex cases with lower urinary tract pathology. Different guidelines exist for performing good urodynamic tests, however, there is no agreed recommendation for the size of the transurethral catheter used.Invasive urodynamics are used to diagnose complex cases with lower urinary tract pathology. Different guidelines exist for performing good urodynamic tests, however, there is no agreed recommendation for the size of the transurethral catheter used.

The option of Active Surveillance for patients with localized prostate cancer depends on a low GleasonScore (GS) of 6. Nevertheless about 30%have to face clinical progression within five years. Our hypothesis is that automated measurements of DNA-content of prostate cancer cells yield a DNA-grade of malignancy [1-4] that is able to predict non-progression of prostate cancers at much higher accuracy than the subjective GS. Nuclear DNA-measurements were performed from cancer tissue in residual biopsy-material of 80 patients from the HAROW-study. Local- and a reference pathologists GSs were available. Follow-up of mean 4,1 years included repeated PSA-values, number and GSs of positive biopsies, clinical stage, and in19cases results from prostatectomies. Reproducibility of GSs was 55% without and 45% with differentiation between 6 and 7a. Progression occurred in 37.5% if upgrade of any inclusion criterion was used as evidence and in 18,8% if only PSA-DT <36 months or upstaging to pT3. Prevalence of DNA-grade 1 was 40%.Sensitivity, specificity and negative predictive value of local pathologists GS, reference pathologists GS and DNA-karyometry were: 0%, 95.0% and 74.0%, 20.0%, 86.7% and 76.5%, 85.0%, 51.0% and 90.6%, if upgrade of any criterion of inclusion was used as evidence of progression and 5.9%, 96.8% and 79.2%, 23.5%, 87.3% and 80.9%, 100%, 50.8% and 100% if only PSA-DT < 36 months and/or upstaging to pT3 were used. Thus, objective automated DNA-karyometry can much more reliably exclude progression of prostate cancers under Active Surveillance within four years as compared with subjective Gleason-scoring.

Patient summary: The probability to exclude an objectively assessed progression of an untreated, localized prostate cancer under Active Surveillance was only 80.9% for the subjective microscopic Gleason-score but 100% for objective DNA-karyometry. Thus, patients with DNA-grade of malignancy 1 can much more safely rely on this conservative, non invasive therapeutic strategy

Colovesical Fistula (CVF) is a relatively rare, but potentially devastating complication of pelvic radiation. The entity has been associated with severe malnutrition and the success or failure of subsequent therapy may be dependent on a patient’s nutritional status. We describe our experience with a patient who developed a severe colovesical fistula six months after completing radiation therapy and his clinical course thereafter. Ultimately, nutritional status is of the utmost importance when approaching curative therapy in patients who may already suffer from malnutrition.