1/92. Enterovesical fistula complicating pregnancy. A case report.BACKGROUND: Enterovesical fistula is a rare cause of recurrent urinary tract infections. This condition is unusual in young people as common etiologies include diverticular disease and cancer. When an enterovesical fistula occurs in women of childbearing age, Crohn's disease is a likely cause. To our knowledge, enterovesical fistula complicating pregnancy has not been reported before. CASE: A pregnant woman with recurrent urinary tract infections was evaluated. cystoscopy was suggestive of an enterovesical fistula, which was confirmed by charcoaluria following oral charcoal administration. The prenatal course was complicated by two episodes of hemorrhagic cystitis despite antibiotic prophylaxis. The patient had an uncomplicated term spontaneous vaginal delivery. An upper gastrointestinal series performed postpartum was suggestive of Crohn's disease and confirmed an enterovesical fistula. Surgical repair was successfully performed three months following delivery, revealing Crohn's disease. CONCLUSION: Enterovesical fistula may be an unusual cause of recurrent urinary tract infections in pregnancy. In this case, enterovesical fistula was the presenting symptom of Crohn's disease.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
2/92. Vesicocutaneous fistula 23 years after hip arthroplasty. A case report.Vesicocutaneous fistula after total hip replacement is a very rare but severe complication, which can appear months or years after operation. Intrapelvic cement (methylmethacrilate) spilling, loosening and dislocation of the prosthesis and infection are believed to be the cause of fistula formation. Only 4 cases of this kind of fistula have been reported in the literature. A new case of vesicocutaneous fistula is presented. The fistula developed 23 years after arthroplasty mainly because of hip-joint infection. Urinary tract symptoms caused by urinary infection appeared only few months earlier.- - - - - - - - - - ranking = 0.33333333333333keywords = urinary (Clic here for more details about this article) |
3/92. Appendico-vesical fistula. A new case and a brief review of the literature.A new case of appendico-vesical fistula is submitted. After a brief review of the literature, it is concluded that these fistulas usually manifest themselves clinically in recurrent urinary infections without gastro-intestinal symptoms. The best aids in the difficult diagnosis are cystography and cystoscopy. Treatment is by appendectomy and excision of the fistular opening.- - - - - - - - - - ranking = 0.33333333333333keywords = urinary (Clic here for more details about this article) |
4/92. Metabolic acidosis during urinary retention in a patient with an enterovesical fistula.We report a patient known to have an enterovesical fistula who presented severe acute metabolic acidosis during an episode of urinary retention. The enterovesical fistula which had been intermittently symptomatic for 4 years, had developed after several intestinal surgical procedures and related intraperitoneal sepsis following resection of colon cancer 21 years previously. The patient who had a total colectomy and ileostomy, was admitted for hip replacement with the routine placement of a Foley bladder catheter. Three weeks post-operatively, the patient developed acute urinary retention following removal of the urinary catheter. The output from his ileostomy was immediately markedly increased, presumably from bladder urine diverted into the intestines through the enterovesical fistula. Within a few days he presented a normal anion gap metabolic acidosis with raised urea and stable creatinine; his clinical status deteriorated markedly with profound obtundation. These metabolic abnormalities were readily corrected by re-insertion of the Foley catheter with restoration of normal urine flow and immediate corresponding fall in the ileostomy output. Radiographic studies showed the presence of the enterovesical fistula originating from the jejunum. This is the first report of acute metabolic acidosis in association with an enterovesical fistula; the severe metabolic disturbances were triggered by the development of urinary retention resulting in the diversion of urine into the small bowel through the fistula.- - - - - - - - - - ranking = 2.6666666666667keywords = urinary (Clic here for more details about this article) |
5/92. Timing of surgery for enterovesical fistula in Crohn's disease: decision analysis using a time-dependent compartment model.OBJECTIVES: Previous decision analyses of inflam matory bowel diseases (IBD) have used decision trees and markov chains. Occasionally IBD patients present with medical problems that are difficult or even impossible to phrase in terms of such established decision tools. This article aims to introduce modeling by a time-dependent compartment mode and demonstrate its feasibility for decision analysis in IBD methods: A Crohn's disease patient presented with a pelvic abscess and an enterovesical fistula. Being hesitant to operate in an acutely inflamed area, the surgeon recommended that the patient continue antibiotic therapy until the abscess had re solved. The gastroenterologist argued that the patient had already been treated with antibiotics for a prolonged time period and expressed concern that the patient's overall diminished health status would deteriorate by further delay of surgery. The occurrence of fistula, abscess, urinary tract infection, antibiotic therapy, surgical operation, and health-related quality of life were modeled as separate compartments, with time-dependent relationships among them. The simulation was carried out on an Excel spreadsheet. RESULTS: In the model, the surgeon's predictions were associated with rapid resolution of the pelvic abscess under antibiotic therapy and improvement of the patient's health status. The gastroenterologist's predictions resulted in a smaller decline in abscess size and further deterioration of the patient's health while waiting for a definitive treatment. The disagreement between surgery and gastroenterology arose from predicting different time courses for the individual disease events, in essence, from assigning different time constants to the time-dependent influences of the disease model. CONCLUSIONS: The compartment model provides a simple and generally applicable method to assess time dependent-changes of a complex disease. The present analysis also serves to illustrate the usefulness of such models in simulating disease behavior.- - - - - - - - - - ranking = 0.33333333333333keywords = urinary (Clic here for more details about this article) |
6/92. Primary Epstein-Barr virus-associated hodgkin disease of the ileum complicating crohn disease.We describe a case of primary hodgkin disease of the terminal ileum in a 38-year-old man with crohn disease of 24 years' duration. The infiltrate was located in an ulcerated fistula involving the terminal ileum and urinary bladder. reed-sternberg cells and their variants were characteristically positive for CD15, fascin, and CD30 and showed focal positivity for CD20. Epstein-Barr virus messenger rna was also detected in the neoplastic cells. Staging revealed no evidence of other lymph node or organ involvement. Although rare, primary gastrointestinal hodgkin disease arising in the setting of crohn disease may have a stronger association with Epstein-Barr virus infection than conventional hodgkin disease.- - - - - - - - - - ranking = 0.33333333333333keywords = urinary (Clic here for more details about this article) |
7/92. Repair of a fistula between the bladder and the perineal skin by femoral gracilis flap interposition.The successful repair of a fistula between the bladder and the perineal skin using a femoral gracilis flap is reported. A 70-year-old woman, who 10 years previously had undergone a total hysterectomy for uterine cancer, developed a fistula between the bladder and the perineal skin after she underwent Mile's operation for rectal cancer. Initially, an attempt was made to repair the fistula by the transabdominal approach. This failed, probably because of the lack of supporting tissue between the bladder and the perineal skin. The second repair was performed with plastic surgeons. A secure three-layer bladder closure was accomplished. A right femoral gracilis flap was developed and rotated 180 degrees to fill the defect in the skin and subcutaneous tissue. Four weeks after surgery, cystography revealed no fistula or urinary leakage and the drainage catheter was removed. Femoral gracilis flap interposition was successful for repair of a fistula between the bladder and the perineal skin when there was no supporting tissue due to extensive exenteration in the surgical removal of rectal cancer and after other repair procedures had been unsuccessful.- - - - - - - - - - ranking = 0.33333333333333keywords = urinary (Clic here for more details about this article) |
8/92. A case report on vesico-uterine fistula: a very rare complication of the lower caesarean section.Vesico-uterine fistula is a very rare complication of lower caesarean section. There has only been two cases seen at the Department of urology in the past 2 decades. patients usually present in the early post operative period with the problem of continuous urinary incontinence. On the rare occasion, recurrent urinary tract infection, recurrent gross painless haematuria, or secondary infertility associated with secondary amenorrhoea would be the presenting complaint.- - - - - - - - - - ranking = 7.0988224943727keywords = urinary incontinence, incontinence, urinary (Clic here for more details about this article) |
9/92. Conservative treatment of iatrogenic urinary fistulas: the value of cyanoacrylic glue.Once previously attempted conservative maneuvers have failed, iatrogenic persistent urinary fistulas usually require difficult repeated operations. We describe 3 patients in whom cyanoacrylic glue was used to repair endoscopically persistent urinary fistulas occurring after major pelvic surgery. At a mean follow-up of 21 months, all patients were free of urinary leakage and had no evidence of recurrent urinary fistulas. This approach may represent a safe and effective way to repair postoperative urinary fistulas.- - - - - - - - - - ranking = 3keywords = urinary (Clic here for more details about this article) |
10/92. Cystoscopic fistulography: a new technique for the diagnosis of vesicocervical fistula.BACKGROUND: Most fistulas communicating with the bladder are large enough to be diagnosed easily, or small enough to close spontaneously without clinical sequel. A vesicocervical fistula is an uncommon event and may be difficult to diagnose. TECHNIQUE: During an operative cystourethroscopy procedure, suspicious areas of the bladder can be probed with a cone tip catheter and injected with contrast dye to visualize the suspected fistula communicating with the bladder. EXPERIENCE: This technique was employed when a double dye test, an intravenous urogram, a cystogram, a computed tomography scan, and a hysterogram failed to localize the fistulous tract in a patient who was 3 weeks postpartum after a repeat cesarean with complaint of persistent urinary incontinence. CONCLUSION: Cystoscopic catheterization of suspicious lesions in the bladder may visualize an otherwise elusive fistulous tract.- - - - - - - - - - ranking = 6.7654891610393keywords = urinary incontinence, incontinence, urinary (Clic here for more details about this article) |
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