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Urinary bladder fistula formation is a complication of significant morbidity and mortality following pelvic surgery or radiotherapy. Surgical treatment is the definitive management, but it may be contraindicated in patients with significant comorbidities. The alternative approach is to divert urine away from the fistula with stents and catheters, and allow time for healing. The case illustrated herein describes the use of alcohol to accelerate the fibrotic healing of a urinary bladder fistula, based on the premise that sclerosing agents have been effective in the treatment of pancreatic fistulas and renal cysts. A Foley catheter is inserted through the external fistula orifice and passed along the fistula tract into the urinary bladder. The Foley catheter balloon is inflated and pulled back to occlude the fistula. Following this, a vascular sheath is placed alongside the catheter and ethanol is injected into the tract. The alcohol is left to dwell in the fistula for a few minutes, after which time the catheter and sheath are removed. The sclerosant effect of the ethanol aims to induce fibrosis, and therefore occlusion, of the fistula.

Background The COVID-19 pandemic has had an unprecedented effect upon the National Health Service (NHS). Like other specialties, Interventional Radiology (IR) rapidly adapted to the evolving situation. Members of BSIR were surveyed to obtain a snapshot of the experiences of UK IRs in response to COVID-19. An electronic survey was compiled using Google Forms, approved by the BSIR Council Officers and distributed to BSIR members by email on 18 th April 2020. A total of 228 responses were received. The survey was open for a 14-day period and the data analysed in Microsoft Excel 365. The response rate was 29% (228/800). Results Two thirds of respondents work in a Tertiary unit and 33% deliver IR in a District Hospital. 84% have a day-case facility. After the COVID-19 crisis, 81% of respondents were able to maintain 24–7 On-call service. 59% of respondents had been required change their day to day practice to allow the on-call service to continue. 55% of respondents were involved in providing a central line service. Of those questioned, 91% continued to offer endovascular services, 98% genitourinary and 92% hepatobiliary services, although a degree of service reduction was described. 38% have provided IR trainees with additional training material during this pandemic. Conclusions This survey has confirmed that the responses of UK IR departments to the COVID-19 crisis have ensured vital on-call and urgent services have continued, including ongoing availability of most IR sub-specialties. Availability of a day case facility has possibly influenced the positive response.

The kidney is the most commonly injured genitourinary organ, and renal involvement has been reported in 1–5% of all trauma cases. Two mechanisms of renal injury are described, namely blunt (direct blow to the kidney, rapid acceleration/deceleration or a combination) and penetrating (from stab or gunshot wounds), with blunt injuries being most common in the UK. It is important to keep an index of suspicion for renal trauma as given by the mechanism of the injury or in poly-trauma. Accurate assessment and resuscitation are vital in the initial management. Imaging with computed tomography is critical to the accurate grading of the injury and helps guide subsequent treatment. The approach to management of renal injuries has changed over time. During the past two decades, advances in cross-sectional imaging coupled with minimally invasive intervention strategies (like angiography, embolisation and ureteric stenting) for managing traumatic renal injuries have allowed increased renal preservation by reducing the need for major surgical intervention. Nowadays, the vast majority of blunt injuries (up to 95%) are managed conservatively with accumulated experience suggesting this is safe. However, there is still a role for open surgical exploration in patients with haemodynamic instability or those who fail initial conservative/minimally invasive management.

The complications of autosomal dominant polycystic kidney disease (ADPKD) include cyst rupture and haemorrhage leading to loin pain and frank haematuria. Risk factors include large kidney volume, hypertension, and renal impairment. We present a case of a young male who, following trauma to the kidney, had a life threatening bleed from his polycystic kidney. The case was initially treated with fluid resuscitation and blood transfusion but necessitated radiological embolization of bleeding source to control the blood loss. We review the risk factors and management of cyst haemorrhage in patients with ADPKD. Contact sports should be avoided as cyst rupture can lead to severe life threatening haemorrhage.

Interventional radiology is a relatively young specialty, and it is undergoing a period of considerable growth. The benefits of a minimally invasive approach are clear, with smaller incisions, less pain, and faster recovery times being the principal benefits compared to surgical alternatives. Trainees need to acquire the technical skills and the clinical acumen to accurately deliver targeted treatment and safely follow up patients after the procedure. The need to maintain an efficient interventional radiology service whilst also giving sufficient time for trainee education is a challenge. In order to compensate for this, novel technologies like virtual reality (VR), augmented reality (AR), cadaveric simulation, and three-dimensional (3D) printing have been postulated as a means of supplementing training. In this article, we outline the main features of these innovative strategies and discuss the evidence base behind them. Benefits of these techniques beyond pure clinical training include the standardization of educational cases, access to training at any time, and less risk to patients. The main disadvantage is the large financial outlay required. Therefore, before widespread uptake can be recommended, further research is needed to confirm the educational benefit of these novel techniques, both in and of themselves and in comparison to existing clinical-based education.

An 81-year-old gentleman with chronic kidney disease presented with pyrexia and a new systolic cardiac murmur. Investigations revealed infective aortitis of a pre-existing aortic aneurysm graft repair. Peripheral blood cultures were positive for Yersinia pseudotuberculosis and the patient was successfully treated with an extended course of antibiotics. Abdominal imaging also revealed progressive bilateral polycystic kidney disease with associated diverticular disease, which was postulated as the source of the Y. pseudotuberculosis. An autosomal dominant polycystic kidney disease may present late in life and extra-renal manifestations of this disease are an important cause of morbidity.

To determine if post-biopsy complication rates were influenced by patient positioning after the procedure.A prospective evaluation of post-biopsy complications in 87 patients (55 men, 32 women; mean age 66 yr, range 20-86 yr) undergoing fine-needle aspiration biopsy of lung nodules was performed. Biopsies were performed under computed tomographic guidance in 66 patients, fluoroscopic guidance in 18 and ultrasonographic guidance in 3 patients. Patients were randomly assigned to be placed either in the lateral decubitus "biopsy-side-down" position or in the "biopsy-site-dependent" position (i.e., lying directly on the skin puncture site) after surgery. Chest imaging was performed immediately and at 4 hours after biopsy.Immediately after the procedure, 6 (14%) of the 42 patients in the decubitus biopsy-side-down group and 15 (33%) of the 45 patients in the site-dependent group experienced pneumothoraces (p0.05). No patient required tube thoracostomy. Two patients in the decubitus group and 1 in the site-dependent group experienced hemoptysis immediately after biopsy. On the 4-hour chest radiographs, there was no progression in size of the existing pneumothoraces.Positioning the patient either decubitus biopsy-side-down or lying directly on the puncture site after lung biopsy does not appear to affect complication rates.