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Wadhwa P, Goel S, Talwar HS, Zafar F. Recurrent vesico-acetabulo-cutaneous fistula: lessons to be learnt. BMJ Case Rep 2022; 15:e250618. [PMID: 35985748 PMCID: PMC9396153 DOI: 10.1136/bcr-2022-250618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A man in early 40s met with an accident with a complex pelvic fracture and extraperitoneal bladder injury and posterior urethral disruption 16 years ago. He additionally had left lumbar spinal segment mixed nerve injury, resulting in a foot drop. He underwent laparotomy and a diverting cystostomy at the time with a primary perineal urethroplasty a year later. He later developed pseudoarthrodesis of the hip joint, and poorly compliant bladder with complete block at bulbar urethra. A redo anastomotic urethroplasty was performed, hyperreflexive neurogenic bladder was managed with intravesical botox injections and underwent a hip replacement. Having defaulted botox injections, he developed a vesico-acetabulo-cutaneous fistula and the hip prosthesis was explanted. Later he underwent a ileal cystoplasty and a revision hip replacement. Ten years later, he presented with a recurrent fistula due to poor compliance with clean intermittent catheterisation. A challenging exploration with fistula excision was done with a primary bladder repair.
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Affiliation(s)
- Pankaj Wadhwa
- Department of Urology, Medanta The Medicity Medanta Institute of Kidney and Urology, Gurugram, Haryana, India
| | - Sunny Goel
- Department of Urology, Medanta The Medicity Medanta Institute of Kidney and Urology, Gurugram, Haryana, India
| | - Harkirat Singh Talwar
- Medanta The Medicity Medanta Institute of Kidney and Urology, Gurugram, Haryana, India
| | - Feroz Zafar
- Medanta The Medicity Medanta Institute of Kidney and Urology, Gurugram, Haryana, India
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Ammirati E, Geretto P, Giammò A, Falcone M, Gontero P, Manassero A. Management of complex ischial-urethral fistula in neurogenic patients performing clean intermittent self-catheterization. Urologia 2021; 90:174-179. [PMID: 34877917 DOI: 10.1177/03915603211062414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Neurogenic patients performing clean-intermittent self-catheterization (CIC) may develop an urethral erosion, resulting in ischial-urethral fistulas (I-UF). In this work we present our single-center experience in dealing with this peculiar complication. METHODS In this work we included all neurogenic patients performing CIC treated at out Institution for I-UF. All patients had a spinal cord injury or myelomeningocele. We extracted from the patients' medical records the surgical management and postoperative clinical data. We defined failure the persistence of the fistula at X-ray contrast fistulography, retrograde urethrography, or uretrocystoscopy. RESULTS We treated 11 patients (8 spinal cord injury, 3 myelomeningocele). Four patients have been treated with the placement of a new generation urethral stent (Uventa) after surgical toilette of the skin ulcer and placement of a temporary suprapubic catheter. All patients demonstrated a complete healing of the urethral lesion at stent removal and continued CIC without any difficulty. Four patients have been treated with perineal urethroplasty, requiring a buccal mucosal graft in two cases. In two patients a suprapubic permanent catheter was placed for a simpler bladder management due to the patients' comorbidities. In one case the incidental finding of an high grade muscle invasive urothelial bladder cancer, made it mandatory to perform an uretheroileocutaneostomy. CONCLUSIONS This work represent a unique series of I-UF in neurogenic patients performing CIC. Surgical urethral reconstruction, often with the use of buccal mucosa in large lesions, may be a difficult solution in neurogenic patients, new generation stents (Uventa) represent a minimally invasive, effective, and safe alternative.
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Affiliation(s)
- Enrico Ammirati
- SC Neuro-Urologia, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Paolo Geretto
- SC Neuro-Urologia, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Alessandro Giammò
- SC Neuro-Urologia, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Marco Falcone
- SC Neuro-Urologia, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Paolo Gontero
- SC Neuro-Urologia, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Alberto Manassero
- SC Neuro-Urologia, Città della Salute e della Scienza di Torino, Torino, Italy
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Gambachidze D, Lefèvre C, Chartier-Kastler E, Perrouin Verbe MA, Kerdraon J, Egon G, Even A, Denys P, Castel-Lacanal E, Gamé X, Ruffion A, Hascoet J, Peyronnet B, Chaussard H, Verde KL, Karsenty G, Phé V. Management of urethrocutaneous fistulae complicating sacral and perineal pressure ulcer in neurourological patients: A national multicenter study from the French-speaking Neuro-urology Study Group and the Neuro-urology committee of the French Association of Urology. Neurourol Urodyn 2019; 38:1713-1720. [PMID: 31141236 DOI: 10.1002/nau.24047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 05/05/2019] [Accepted: 05/09/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE To describe the epidemiologic characteristics of urethrocutaneous fistulae (UCF) in sacro-perineal pressure ulcer (SPPU) in neurourological patients and to assess outcomes after surgical urinary diversion. MATERIALS AND METHODS Through the French-speaking Neurourology Study Group and Association of Urology network, a retrospective multicenter study in nine major urology and physical medicine and rehabilitation (PMR) units was conducted. All patients with SPPU associated with UCF between 2000 and 2016 were included. Data concerning: sociodemography, clinical, medical and biological comorbidities, neurological and urological history, pressure ulcer characteristics, and finally urinary diversion surgery were collected. Complications and SPPU healing/relapse were assessed. RESULTS In all, 74 patients were included. The median age on diagnosis: 45.9 years (interquartile range [IQR], 38.7-53.4) and median follow-up: 15.1 months (IQR, 5.7-48.8). A psychiatric disorder was the most frequent comorbidity (44.6%). Only 59.5% and 50% had regular PMR and urologic follow-up, respectively. Seventy-one patients (95.9%) underwent urinary diversion surgery. Among those, relapse occurred in 15 (21.1%) at the end of the follow-up. The diversion was noncontinent in 85.9%. The major complications rate was 26.8%. A total of 30 late complications in 21 patients were reported. The most frequent was obstructive pyelonephritis (n = 9). All of the patients who underwent surgical diversion without cystectomy (n = 5) developed a pyocyst. Finally, the pressure ulcer healing rate when patients underwent both urinary diversion and pressure ulcer surgery was 74.4%. CONCLUSIONS Our retrospective data suggest that UCF complicating SPPU is a rare and severe pathology. The combination of radical urinary diversion with cystectomy and pressure ulcer surgery should be performed as often as possible.
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Affiliation(s)
- Dimitri Gambachidze
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Médecine Sorbonne Université, Paris, France
| | - Chloë Lefèvre
- Department of Physical Medicine and Rehabilitation, CHU de Nantes, Nantes, France
| | - Emmanuel Chartier-Kastler
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Médecine Sorbonne Université, Paris, France.,Department of Physical Medicine and Rehabilitation, Raymond Poincaré Academic Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Ouest Medical School, Versailles-Saint-Quentin en Yvelines University, Montigny le Bretonneux, France
| | | | - Jacques Kerdraon
- Department of Physical Medicine and Rehabilitation, Kerpape Hospital, Ploemeur, France
| | - Guy Egon
- Department of Physical Medicine and Rehabilitation, Rehabilitation Centre of L'Arche, Saint Saturnin, France
| | - Alexia Even
- Department of Physical Medicine and Rehabilitation, Raymond Poincaré Academic Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Ouest Medical School, Versailles-Saint-Quentin en Yvelines University, Montigny le Bretonneux, France
| | - Pierre Denys
- Department of Physical Medicine and Rehabilitation, Raymond Poincaré Academic Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Ouest Medical School, Versailles-Saint-Quentin en Yvelines University, Montigny le Bretonneux, France
| | | | - Xavier Gamé
- Department of Urology, CHU Rangueil, Toulouse, France
| | - Alain Ruffion
- Department of Urology, Lyon Sud Hospital, Lyon University Hospital, Lyon, France
| | - Juliette Hascoet
- Department of Urology, Lyon Sud Hospital, Lyon University Hospital, Lyon, France
| | | | - Haude Chaussard
- Department of Orthopedic Surgery, Raymond Poincaré Academic Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Kévin Lo Verde
- Department of urology, Aix Marseille Université, Marseille, France
| | - Gilles Karsenty
- Department of urology, Aix Marseille Université, Marseille, France
| | - Véronique Phé
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Médecine Sorbonne Université, Paris, France
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Abstract
PURPOSE OF REVIEW To present the available literature pertaining to the management of lower urinary tract symptoms (LUTS) after pelvic radiation (RT) in female patients treated for pelvic malignancy. RECENT FINDINGS Recent publications have focused on isolating de novo RT-induced LUTS in women from other contributors to urinary symptoms such as pelvic surgery and chemotherapy. There is a paucity of literature on the treatment of RT-related changes to urinary function. The treatment of pelvic malignancies in women alters voiding function. RT contributes to the deterioration of voiding function. More study is needed to evaluate the efficacy of available therapies.
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Affiliation(s)
- Laura S Leddy
- Memorial Sloan-Kettering Cancer Center, 353 East 68th Street, New York, NY, 10065, USA.
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