Cases reported "Urinary Bladder Fistula"

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1/46. Rectovesical fistula treated by covered self-expanding prosthesis: report of a case.

    Postoperative rectovesical fistulas require surgical intervention for their treatment. We present a case treated by placement of a silicone self-expanding prosthesis in the rectum and vesical drainage and give technical details of the procedure.
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2/46. 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.
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3/46. 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.
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4/46. 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.
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5/46. 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.
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6/46. Efficacy of 3-D computed tomographic reconstruction in evaluating anatomical relationships of colovesical fistula.

    A case of colovesical fistula is reported. The anatomy of the pelvis was determined preoperatively with 3-D computed tomography (CT), and the fistula, including adjacent structures, could clearly be seen. Compared with conventional axial CT imaging, 3-D CT provided better and more complete visualization of the anatomical relationships, which facilitated the surgical procedure and provided a good outcome.
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7/46. Multiple ileal diverticula causing an ileovesical fistula: report of a case.

    We report a case of multiple ileal diverticula causing an ileovesical fistula in an 85-year-old man. The patient was admitted for investigation and treatment of intractable urethrocystitis, which he had suffered for 5 years. Cystography showed an ileovesical fistula, and contrast study of the small bowel revealed about 80 diverticula in the ileum. The segment involved by diverticula was resected and a pathological diagnosis of diverticulitis leading to ileovesical fistula was confirmed. His postoperative clinical course was uneventful.
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8/46. Case report: the transvesical approach to a traumatic rectovesical fistula.

    A case of traumatic rectovesical fistula in a 14-year-old boy is presented. A transvesical approach was employed to access the defect. This approach provided excellent exposure, ease of surgery, and an uncomplicated post-operative course. The operative procedure is described, and aspects of the case are discussed.
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9/46. Vesicouterine fistulas following cesarean section: report on a case, review and update of the literature.

    Herein we report on 1 more case of vesicouterine fistula following cesarean section with review and update of the literature concerning this unusual topic. The disease presented with vaginal urinary leakage, cyclic hematuria and amenorrhea. The fistula was successfully repaired by delayed surgery. Actually, all over the world the prevalence of the disease is increasing for the frequent use of the cesarean section. Fistulas may develop immediately after a cesarean section, manifest in the late puerperium or occur after repeated procedures. Spontaneous healing is reported in 5% of cases. Vesicouterine fistulas present with vaginal urinary leakage, cyclic hematuira (menouria), amenorrhea, infertility, and first trimester abortions. The diagnosis is ruled out by showing the fistulous track between bladder and uterus as well as by excluding other more frequent urogenital fistulas. The disease treatment options include conservative treatment as well as surgical repair. Rarely, patients refuse any kind of treatment because of the benignity of symptoms and prognosis of the disease. Conservative management by bladder catheterization for at least 4-8 weeks is indicated when the fistula is discoveredjust after delivery since there is good chance for spontaneous closure of the fistulous track. Hormonal management should be tried in women presenting with Youssef's syndrome. Surgery is the maninstay and definitive treatment of vesicouterine fistulas after cesarean section. patients scheduled for surgery should undergo pretreatment of urinary tract infections. Surgical repair of vesico-uterine fistulas are performed by different approaches which include the vaginal, transvesical-retroperitoneal and transperitoneal access which is considered the most effective with the lowest relapse rate. Recently, laparoscopy has been proposed as a valid option for repairing vesicouterine fistulas. The endoscopic treatment may be effective in treating small vesicouterine fistulas. The pregnancy rate after repair is 31.25% with a rate of term deliveries of 25%. The disease may be prevented by emptying the bladder as well as by carefully dissecting the lower uterine segment. It is advisable that after vesicouterine fistula repair delivery should be performed by repeating a cesarean section since the risk of fistula recurrence. Usually, vesicouterine fistulas are diagnosed postoperatively. As a result, at least 95% of patients will undergo another operation for repairing the fistula. In the meantime they are bothered by related symptoms which impair their quality of life. As far as we are concerned intraoperative diagnosis is the gold standard in detecting vesicouterine fistulas for allowing immediate repair. We propose intraoperative sonography by the transvaginal (or transrectal) route for the Foley transurethral catheter producing bloody urine, for suspecting bladder injury while dissecting the uterine lower segment and for monitoring patients who already had had vesicouterine fistula repair. As a result patients will avoid the familial and social problems related to the disease as well another operation. Moreover, ultrasound Doppler examination may help in better investigating and understanding the pathophysiology of vesicouterine fistulas.
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10/46. Conservative management of a traumatic uterovesical fistula ('Youssef's syndrome').

    'Youssef's syndrome' is characterised by cyclical haematuria, the absence of vaginal bleeding and complete urinary continence. It is a rare complication of caesarean section when bladder injury occurs and a fistula develops. While operative repair may be required, we describe a case that was managed conservatively and resolved without surgical intervention.
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