Fibrin glue and transanal rectal advancement flap for high transsphincteric perianal fistulas; is there any advantage?

BACKGROUNDS AND AIM: In recent decades, fibrin glue has appeared as an alternative treatment for high perianal fistulas. Early results seemed promising, with high success rates being reported. However, with increasing follow-up, the enthusiasm was tempered because of disappointing results. The aim of this retrospective study was to assess the additional value of fibrin glue in combination with transanal advancement flap, compared to advancement flap alone, for the treatment of high transsphincteric fistulas of cryptoglandular origin. MATERIALS AND METHODS: Between January 1995 and January 2006, 127 patients were operated for high perianal fistulas with an advancement flap. After exclusion of patients with inflammatory bowel disease or HIV, 80 patients remained. A consecutive series of 26 patients had an advancement flap combined with obliteration of the fistula tract with fibrin glue. Patients were matched for prior fistula surgery, and the advancement was performed identically in all patients. In the fibrin glue group, glue was installed retrogradely in the fistula tract after the advancement was completed and the fistula tract had been curetted. RESULTS: Minimal follow-up after surgery was 13 months [median of 67 months (range, 13-127)]. The overall recurrence rate was 26% (n=21). Recurrence rates for advancement flap alone vs the combination with glue were 13% vs 56% (p=0.014) in the group without previous fistula surgery and 23% vs 41% (p=0.216) in the group with previous fistula surgery. CONCLUSION: Obliterating the fistula tract with fibrin glue was associated with worse outcome after rectal advancement flap for high perianal fistula

Management of non-muscle-invasive and muscle-invasive bladder cancers

Bladder cancer (BC) is the 7th most commonly diagnosed cancer in men worldwide, while it declines to 11th when both sexes are considered. The worldwide age-standardized incidence rate (per 100,000 person/years) is 9.0 for men and 2.2 for women. Europe has among the highest incidence rates of BC in the world, where the age-standardized incidence rate is 19.1 for men and 4.0 for women. The overall burden was greater in men; however varying incidence trends by gender were reported recently in some countries, with rates drop in male and increase in female population. The management of BC should be tailored according to the disease stage, grade, and patient-related factors at the presentation. In this chapter, we will discuss the management of non-muscle- invasive disease and the surgical management of muscle-invasive disease. © Springer International Publishing AG 2017