1/27. Our surgical approach towards the treatment of urethrocele and urethral fistula.A new technique, described in the text, has been elaborated inspired by that of Monseur (1968) for urethral techniques. It has been performed with success in three paraplegics and in one incomplete tetraparesis. The plastic reconstruction of the diseased part of the urethra after excision of the stenosis and a fistula or diverticula by rotation and fixation to the subcavernal groove creates, in fact, an enlarged neo-urethra rendering the recurrence of the primary lesion practically impossible. This technique, first applied to spinal cord injuries, has been extended with permanent success to other lesions, such as tuberculosis stenosis and malformations.- - - - - - - - - - ranking = 1keywords = stenosis (Clic here for more details about this article) |
2/27. Endourologic management of obstetrical ureterouterine fistula: case report and review of literature.A 32-year-old woman presented to us with complaints of paradoxical incontinence for a period of 6 months following a cesarean section for obstructed labor performed elsewhere and subsequently treated elsewhere. Clinical and urographic assessment revealed an iatrogenic ureterouterine fistula, which was successfully treated endoscopically by dilatation of the ureteral stricture and ureteroscopic double-J stenting. It had been explained to the patient, and she had given consent for, ureteroneocystostomy in the event of failure. The literature regarding the management of this rare genitourinary fistula is reviewed and discussed.- - - - - - - - - - ranking = 66.734254081633keywords = stricture (Clic here for more details about this article) |
3/27. Ureteroenteric fistula after retrograde balloon dilatation of ureteral stricture.Advances in endourology have made transluminal balloon dilatation a safe and effective procedure for the treatment of ureteral strictures. Bilateral ureteral stricture was treated with retrograde balloon dilatation and ureteral stenting in a 59-year-old-woman. The patient had previously undergone abdominoperineal resection and adjuvant radiotherapy due to rectosigmoid adenocarcinoma. Subsequently, unilateral ureteroenteric fistula was detected on follow-up retrograde ureteropyelography. To our knowledge, this is the first case of ureteroenteric fistula after balloon dilatation for ureteral stricture in a patient with predisposing factors for compromised vascularity of the ureter.- - - - - - - - - - ranking = 467.13977857143keywords = stricture (Clic here for more details about this article) |
4/27. Transurethral coil embolization for the management of ureteroarterial fistula: a case report.A 71-year-old woman who had undergone a total abdominal hysterectomy and pelvic irradiation for cervical cancer and fecal diversion for adhesive ileus was referred to us for a "left" ureteral stone and intermittent gross hematuria. Bilateral ureteral stents had been indwelled because of lower ureteral strictures for a long time. hematuria continued after the removal of the ureteral stone, and she once went into hypovolemic shock at the time of exchange of the right ureteral catheter. Selective arteriography revealed a "right" ueteroarterial fistula. Endovascular management alone failed to resolve the fistula, but a subsequent transurethral metal coil embolization was effective, and the hematuria was relieved. She is still free from disease at 7-month followup. As far as we know, there has been no previous report of a transurethrally managed ureteroarterial fistula.- - - - - - - - - - ranking = 66.734254081633keywords = stricture (Clic here for more details about this article) |
5/27. Urethrovasocutaneous fistula in a case of anterior urethral stricture.The occurrence of an urethrovasocutaneous fistula is an extremely rare event. We report the first case of such a fistula in a patient with anterior urethral stricture. The patient had epididymo-orchitis preceding the occurrence of the fistula. Increased intravesical and intraurethral pressure during voiding and the patulous ejaculatory ducts were the predisposing factors in this case. The patient was managed successfully by visual internal urethrotomy, bilateral vasectomy and excision of the fistula.- - - - - - - - - - ranking = 55279.533475057keywords = urethral stricture, stricture (Clic here for more details about this article) |
6/27. Rectourethral fistula associated with two short segment urethral strictures in the anterior and posterior urethra: single-stage reconstruction using buccal mucosa and a radial forearm fasciocutaneous free flap.INTRODUCTION: We report a novel surgical technique used to repair a rectourethral fistula associated with two short-segment urethral strictures located in the anterior and posterior segments of the urethra in a patient with prior unsuccessful repairs. TECHNICAL CONSIDERATIONS: The anterior urethral stricture was reconstructed with a ventral onlay of buccal mucosa in the exaggerated lithotomy position. In a modified prone position, the rectourethral fistula was repaired using the transrectal transsphincteric (York-Mason) technique and the posterior urethral stricture with a radial forearm fasciocutaneous free flap which was anastomosed to the inferior gluteal artery and vein. The coexistence of a rectourethral fistula and distal urethral stricture requires simultaneous repair, because the urethral pressure from the distal obstruction may compromise fistula closure. Reconstructive efforts should be tailored to minimize disruption of the urethral blood supply in patients with previous pelvic trauma. Rectal and urethral repairs should be separated by well-vascularized tissue to prevent fistula recurrence. CONCLUSIONS: The radial fasciocutaneous flap may offer the reconstructive surgeon another surgical option for complex urethral stricture and rectourethral fistula reconstruction when the local blood supply is in question. Longer follow-up and more cases are needed to further evaluate the continued use of this technique.- - - - - - - - - - ranking = 99503.160255102keywords = urethral stricture, stricture (Clic here for more details about this article) |
7/27. Anterior transanal, transsphincteric sagittal approach for fistula repair secondary to laparoscopic radical prostatectomy: a simple and effective technique.INTRODUCTION: To report our experience with the anterior, transanal, transsphincteric, sagittal approach in the correction of rectourinary fistula secondary to laparoscopic radical prostatectomy. TECHNICAL CONSIDERATIONS: Of the first 110 laparoscopic extraperitoneal radical prostatectomies performed from December 2001 to February 2004, 9 (8%) were complicated by rectal injury. Of the nine rectal lesions, seven were diagnosed intraoperatively and the rectal defects closed laparoscopically. Primary repair failed in 1 of the 7 patients. In 2 other patients, the rectal injuries were missed intraoperatively, and a rectourinary fistula later developed. Rectourinary fistula was confirmed in these 3 patients by cystoscopy and digital rectal examination. The procedure chosen for repair was the anterior sagittal transrectal anal approach. The time from diagnosis to fistula repair was 1 to 3 months. Fistula repair was successful in all patients. The mean follow-up was 12 to 24 months. No patient presented with fecal incontinence or anal strictures. Postprostatectomy urinary continence was not affected by the procedure. CONCLUSIONS: The transsphincteric transanal surgical approach provides many advantages for the repair of acquired urethrorectal fistulas after laparoscopic radical prostatectomy. It allows for good surgical exposure and fistula tract identification and ensures good access to well-vascularized tissue. This surgical technique is simple, effective, reproducible, and associated with minimal morbidity.- - - - - - - - - - ranking = 66.734254081633keywords = stricture (Clic here for more details about this article) |
8/27. Late caliceal fistula after kidney transplantation.Caliceal fistula is a rare urological complication that can occur usually shortly after kidney transplantation (KTx). The occlusion of the renal accessory artery with subsequent necrosis of the kidney pole is the most common cause of the fistula development. We report a case of a 57-year-old man with reconstruction of two accessory renal arteries by anastomosis to the side of the main artery during graft placement complicated by late caliceal fistula, managed surgically. Directly after KTx good kidney graft function (serum creatinine concentration 151 micromol/L) was observed. The patient noticed protuberance and pain in the kidney graft area 5 months later. diagnostic imaging revealed moderate urostasis and liquid collection in the region of the lower graft pole. Administration of a contrast medium through the inserted drain visualized a fistula of a lower renal calyx and ureteric stenosis. Percutaneous drainage was applied with subsequent stop of diuresis through the urethral catheter. During the surgery, the resection of a lower kidney graft pole necrosis was performed, with the closure of caliceal fistula. Simultaneously double pigtail ureteric stent was inserted. After the next two months the pigtail catheter was removed, and neither urostasis in the kidney graft nor liquid collection in the perigraft area were observed. The exceptionality of the case is the late caliceal fistula occurrence. We may only speculate, why it happened 5 months after KTx. The thrombosis of stenosed accessory artery is the most probable cause.- - - - - - - - - - ranking = 0.5keywords = stenosis (Clic here for more details about this article) |
9/27. Single system ectopic ureter to rectum subtending solitary kidney and bladder agenesis in newborn male.We report a case of a single system solitary ectopic ureter to the rectum with bladder agenesis in a viable newborn male. Only 2 cases of ectopic ureter to the rectum and 18 cases of bladder agenesis have been reported in viable newborns. To our knowledge, this case constitutes the first reported combination of these defects in a living neonate. Associated anomalies also included renal dysplasia, anal stenosis, and urethral-rectal fistula. nephrectomy is often necessary to prevent infection or hypertension.- - - - - - - - - - ranking = 0.5keywords = stenosis (Clic here for more details about this article) |
10/27. Conservative therapy of rectourethral fistula: five-year follow-up.A case of rectourethral fistula is described, occurring after radical prostatectomy and adjuvant radiotherapy for pathologic Stage C carcinoma of the prostate. Urethral instrumentation for stricture disease immediately preceded development of the stricture. Conservative management for five years has resulted in the development of osteomyelitis of the pubis, but with antibiotic suppression the patient remains active and asymptomatic. Predisposing factors for the development of rectourethral fistula following radical prostatectomy may include adjuvant radiotherapy and recurrent urethral instrumentation. Most patients will require definitive repair but occasionally a patient may be managed conservatively.- - - - - - - - - - ranking = 133.46850816327keywords = stricture (Clic here for more details about this article) |
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