Cases reported "Urinary Fistula"

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11/74. Ureteral stent--help or hindrance? In healing of post traumatic nephrocutaneous fistula.

    Nephrocutaneous fistulas are rare complications of blunt or penetrating renal trauma. The majority are managed conservatively, some may require percutaneous drainage or ureteral stenting and some require operative intervention. Diversion of the urine by a ureteral stent usually aids in the healing of the fistula. We present an unusual case of nephrocutaneous fistula following blunt renal trauma which persisted as long as a stent was in place but healed immediately after the stent was removed.
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keywords = operative
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12/74. Congenital urethral fistula with normal anus: a report of two cases.

    Congenital rectourethral or anourethral fistulae without imperforate anus in males are rare, representing less than 1% of anorectal malformations. We report our experience with two males with "N type" urethral fistulae. One, a 5-year-old boy, presented with recurrent urinary tract infections (UTIs) and passage of urine per anus. Investigations included a voiding cystourethrogram (VCUG), which demonstrated a fistula from the urethra to the anus. On physical examination, a small perianal opening was noted just outside the anus, which drained a small amount of urine after voiding. The fistula was excised via a perineal approach. The second patient is a 5-year-old boy with a long history of recurrent UTI requiring multiple hospitalizations since the newborn period. Chronic renal failure developed as a complication of repeated urinary tract infections. Investigations showed a single hydronephrotic pelvic kidney and a small bladder. He underwent numerous diagnostic and reconstructive procedures including cystoscopy and augmentation cystoplasty. Recurrent infections continued and an N type anourethral fistula was eventually diagnosed. The fistula was located between the anal canal and the membranous urethra. An anterior perineal approach was also used. Both fistulae were easily located, and reconstructive surgery of the urethra was not required. Postoperative VCUGs in both patients were normal. They have been free of infection with normal urinary continence since resection of the fistula. Congenital N type anourethral fistulae are rare, but should be considered in cases of recurrent urinary tract infections. The diagnosis may be missed by endoscopic procedures, but VCUG should demonstrate the fistulous tract.
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keywords = operative
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13/74. Endorectal pull-through with posterior sagittal approach to the repair of postoperative rectourethral and rectovaginal fistula.

    BACKGROUND/PURPOSE: Rectourethral (RUF) or rectovaginal fistula (RVF) is a troublesome complication after anorectal surgery because of dense adhesions around the fistula. The authors applied a new technique for the redo surgery. methods: Case 1 is Hirschsprung's disease in a 1-year-old boy who underwent modified Duhamel's procedure and had RUF. Case 2 is rectovestibular fistula in an 11-year-old girl who had anterior sagittal anorectoplasty complicated by RVF. Case 3 is multiple urogenital anomalies including rectovesical fistula in a 4-year-old boy in whom transvesical repair was unsuccessful. The colon was mobilized as far as possible at laparotomy. The rectum was opened via a posterior sagittal approach leaving 1 cm of the anal canal. Extended endorectal mucosectomy was performed to the dentate line, and the fistula was closed from inside of the rectum. The remaining mucosal cuff was everted out of the anus and the intact colon was pulled through the rectum and anastomosed to the cuff extraanally. RESULTS: The postoperative contrast enema showed no recurrent fistula, and defecation was not impaired. CONCLUSIONS: Endorectal pull-through of the intact colon can spare troublesome mobilization of the fistula and can prevent the recurrence of fistula. Rectal incision via a posterior sagittal approach provides a direct view of the fistula.
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ranking = 5
keywords = operative
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14/74. Anorectal agenesis with a rectourethral fistula diagnosed in an adult: report of a case.

    We report an unusual case of anorectal agenesis with a rectourethral fistula diagnosed in a 48-year-old man. The patient presented after noticing hematuria, although he had been aware of urinary leakage from his colostomy with occasional fecal urine for about 4 years. He had had a double-barrel colostomy created soon after birth for an imperforate anus, with revision at the age of 4 years to correct a prolapse of the stoma, but his malformation had never been repaired. We performed a physical examination, which did not reveal a perineal fistula, but urethrocystography demonstrated high anorectal agenesis with a rectourethral fistula. Thus, we resected the rectourethral fistula and created an end-colostomy. The patient had an uneventful postoperative course, and was discharged in good health on postoperative day 19. To our knowledge, this is the oldest patient to be diagnosed with anorectal agenesis and undergo resection of a rectourethral fistula.
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ranking = 2
keywords = operative
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15/74. ureteroscopy: a new asset in the management of postoperative ureterovaginal fistulas.

    Iatrogenic ureteral injury, an uncommon entity, is primarily caused by complications of gynecologic surgery. This report describes a case of ureterovaginal fistula discovered 13 days after a vaginal hysterectomy. ureteroscopy was performed, with passage of an indwelling ureteral stent for 6 weeks. The patient immediately became continent of urine and the fistula healed, thus avoiding the need for further surgery.
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ranking = 4
keywords = operative
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16/74. Robot-assisted Bricker ileoureteral anastomosis during intracorporeal laparoscopic ileal conduit urinary diversion for prostatocutaneous fistula: case report.

    BACKGROUND AND PURPOSE: The da Vinci robot is useful during minimally invasive surgery in performing intracorporeal suturing. We report one case of its application during laparoscopic ileal conduit urinary diversion for prostatocutaneous fistula. methods: A 58-year-old paraplegic man with a neurogenic bladder and bowel and a long history of urinary incontinence developed a prostatocutaneous fistula after numerous procedures to correct the incontinence. He underwent laparoscopic ileal conduit urinary diversion to improve his quality of life. The da Vinci robot was used to perform the ileoureteral anastomosis. RESULTS: The operative time was 10 hours. The estimated blood loss was <100 mL. There were no intraoperative complications. The patient was started on a clear liquid diet on postoperative day 3. There was no narcotic use because of the patient's neurologic status. The patient was discharged home on day 6. CONCLUSION: Laparoscopic urinary diversion remains a technically challenging procedure. The da Vinci robot is useful during laparoscopic ileal conduit construction.
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ranking = 3
keywords = operative
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17/74. Posterior urethral diverticulum after laparoscopic-assisted repair of high-type anorectal malformation in a male patient: surgical treatment and prevention.

    Currently, laparoscopic-assisted colon pull-through (LACPT) is the treatment of choice for male patients with high-type imperforate anus and rectourethral fistula. Since laparoscopy was introduced for treating this condition, reports concerning post-LACPT complications are rare. Here we discuss the case of a boy, now 3.5 years old, born at 37 weeks' gestation weighing 2,300 g, who was diagnosed with rectobulbar urethral fistula (RUF) at birth. LACPT was performed when the boy was 11 months old and weighed 7.2 kg. No intraoperative complications occurred, and the initial post-LACPT course was uneventful. When he was 2 years old, he developed dysuria requiring urethral catheterization. Diagnostic radiology confirmed a large cystic mass behind the bladder, suggestive of a posterior urethral diverticulum (PUD). Histopathology of the excised mucosa of the cyst showed colonic mucosa, confirming that the cyst was indeed an enlarged residual RUF. We discuss our treatment and our approach to prevention.
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keywords = operative
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18/74. Transsphincteric repair of rectourethral fistulas following laparoscopic radical prostatectomy.

    Rectourethral fistula is a serious complication following laparoscopic radical prostatectomy. We report our experience with a transsphincteric approach in the repair of this uncommon complication. The rectourethral fistula was repaired in a three-stage procedure comprising fecal diversion, transsphincteric repair of the fistula and, finally, closure of the stoma. Two patients with rectourethral fistulas underwent this procedure and the postoperative course was uneventful. In conclusion, a transsphincteric approach in the repair of rectourethral fistula by a three-stage procedure is safe and may be the treatment of choice.
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ranking = 1
keywords = operative
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19/74. Transanal endoscopic microsurgical repair of iatrogenic recto-urethral fistula.

    BACKGROUND: Recto-urethral fistula formation following radical prostatectomy is an uncommon but potentially devastating event. Traditional surgery for such fistulae is technically demanding, jeopardizes continence and usually necessitates a diverting colostomy. We present the case of an iatrogenic fistula treated by a transanal endoscopic microsurgical approach, without recourse to a stoma. METHOD: A 71-year-old man had recently undergone a radical prostatectomy, complicated by significant intra-operative haemorrhage. He subsequently developed a recto-urethral fistula, confirmed clinically and endoscopically. Due to his bleeding diathesis, he was considered for, and underwent, a transanal endoscopic microsurgical (TEMS) repair. CONCLUSION: TEMS is a safe and reliable minimally-invasive surgical technique for the treatment of this difficult condition.
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ranking = 1
keywords = operative
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20/74. Laparoscopic transvesical urethrorectal fistula repair: a new technique.

    INTRODUCTION: Urethrorectal fistulas are rare, and several open operative approaches and techniques have been used in treatment. We report our preliminary experience with laparoscopic transvesical urethrorectal fistula repair after iatrogenic urethrorectal fistula. A 65-year-old man with insulin-dependent diabetes mellitus and peripheral vascular disease was hospitalized 6 months after transurethral resection of the prostate for benign prostatic hyperplasia with a recurrent urinary tract infection, fecaluria, and urine leakage from the rectum during voiding. Urethrocystoscopy revealed a urethrorectal fistula in the prostatic fossa. Primary conservative treatment failed. TECHNICAL CONSIDERATIONS: The patient was placed in the lithotomy position, and the suprapubic tract was dilated to allow a 10-mm telescope. carbon dioxide gas was used to distend the bladder (15 mm Hg, flow rate 3 L/min). Next, two 3-mm pediatric trocars were inserted under direct vision. The fistula was identified and the edge of the fistula excised. A running suture (3-0 PDS, RB needle) was used to close the fistula. Finally, a 16F Foley urethral catheter was passed under direct vision, followed by a suprapubic catheter. On postoperative day 12, retrograde cystography revealed no contrast leakage from the rectum. Follow-up after 3 months showed no recurrence of the fistula. CONCLUSIONS: A transvesical laparoscopic technique might be useful for selective cases of urethrorectal fistula. Other methods of laparoscopic urethrorectal fistula repair have included bivalving of the bladder and omental interposition. The laparoscopic transvesical approach provides many advantages, including easy access and identification of the fistula tract, good surgical exposure, and minimal tissue manipulation.
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ranking = 2
keywords = operative
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