Cases reported "Urinary Fistula"

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1/129. Disseminated herpes simplex virus infection in a renal transplant patient as possible cause of repeated urinary extravasations.

    Disseminated herpes simplex virus type 2 (HSV-2) infections are infrequent in patients receiving organ transplants, but usually have a poor outcome. We describe the case of a renal transplant patient who developed a disseminated HSV-2 infection with repeated urinary extravasations. The diagnosis was carried out using a multiplex polymerase chain reaction nested assay and it suggested HSV-2 as a possible cause of repeated urinary fistulas.
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2/129. Vesicocolonic fistula four years after augmentation colocystoplasty.

    An 8-year-old girl was born with crossed fused renal ectopia and neurogenic bladder due to sacral agenesis. Due to progressive upper tract deterioration and incontinence despite clean intermittent catheterization and pharmacotherapy with anticholinergic agents, the patient underwent augmentation colocystoplasty at the age of 4 years. Four years after surgery the girl was readmitted because of persistent febrile urinary tract infection, persistent metabolic acidosis, and intermittent watery diarrhea. A cystogram revealed a fistula between the dome of the augmented bladder and the transverse colon. The fistula was successfully resected. The presence of enterovesical fistula should always be suspected in a patient with augmented bladder who have late onset of urinary tract infection, metabolic acidosis, and diarrhea.
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3/129. A case of cancerous familial adenomatous polyposis in urinary bladder due to migration of colonic mucosa through rectovesical fistula.

    The patient was a 50-yr-old man who had undergone low anterior resection for rectal cancer at the age of 24 yr in 1966. At that time, gastric and colonic polyposis were indicated. Postoperative anastomotic dehiscence occurred and, by 1985, a rectovesical fistula had formed. In 1986, when the patient was 44 yr old, he was examined at our hospital for constriction of the rectum due to the rectovesical fistula. Abdominoperineal excision of rectum and surgical closure of the fistula were performed, and the patient was kept under observation because of a diagnosis of familial adenomatous polyposis. In 1988, when the patient was 46 yr old, early ascending colon cancer was discovered and total colectomy was performed. Then, in December, 1991, gross hematuria was found. Further examination revealed a tumor on the posterior wall of the urinary bladder lumen, and biopsy showed adenocarcinoma. Pelvic recurrence of the rectal cancer was diagnosed, and total pelvic exenteration was performed. There were no distant metastases; histologically, the tumor of the bladder was thought to be due to colonic mucosa of familial adenomatous polyposis that had migrated to the bladder lumen via the rectovesical fistula and had become cancerous.
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4/129. Rare case of left-sided ureteroduodenal fistula.

    BACKGROUND/AIMS: Ureteroduodenal fistulas are rare and only 11 cases have been reported in the literature since 1918. diagnosis requires careful observation of symptoms. methods: The case presented demonstrates a 68-year-old female with left-sided ureteroduodenal fistula confirmed by CT scan. A duodenal fistula was localized and an atrophic left kidney was identified and repaired. RESULTS: Nephroureterectomy was performed and an omental patch was used for the repair. No complications were encountered during the postoperative course. CONCLUSIONS: Recurrent chronic urinary tract infection, pyuria and hematuria can indicate this rare disease. Early testing and detection can improve the chances of renal preservation.
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5/129. A modified nephrostomy in the management of urinary fistula after renal transplantation.

    A technique for complete urinary diversion was used in the management of urinary fistula following renal transplantation. Nephrostomy was modified by closing the renal pelvis at the ureteropelvic junction. No impairment of renal function occurred. In the presence of infection, it is reasonable first to treat the infection and postpone the reconstructive procedure until the infection has subsided.
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6/129. Use of balloon catheters for ureteral occlusion in urinary leakage.

    PURPOSE: urinary fistula after treatment for cancer constitutes a therapeutic dilemma, especially in patients who have had various other treatments. We report on 7 patients with urinary leakage, treated conservatively with ureteric occlusion by way of percutaneous transrenal balloon catheters. MATERIALS AND methods: The indication for ureteral occlusion was persisting urinary leakage despite diversion by nephrostomy and drainage with atransurethral catheter. All patients had had previous treatment because of pelvic malignancy. Small Foley balloon catheters and angioplasty catheters were used. These devices were inserted percutaneously in an antegrade fashion. RESULTS: In all but 2 of the patients the leakage ceased with the aid of these devices. Insufficient ureteral occlusion necessitated unilateral uretero-cutaneostomy in 1 patient. In another patient a vesico vaginal fistula was closed surgically. The maximum duration of occlusion was 169 (mean 94, range 45-169) days, without any evidence of ureteric pressure necrosis. Despite good overall results many adjustments and replacements of catheters were necessary because of recurrent urinary leakage caused by inadequate obstruction and/or leakage of the occluding catheters. CONCLUSIONS: We conclude that long-term ureteral occlusion with percutaneous transrenal balloon catheters appears to be safe and does not result in pressure necrosis. Using this approach, urinary fistula can heal in some patients without the need for open surgery.
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7/129. Practical approach to terminate urinary extravasation: percutaneous fistula tract embolization with N-butyl cyanoacrylate in a case with partial nephrectomy.

    A 35-year-old woman who underwent partial nephrectomy had prolonged postsurgical urinary extravasation that led to a percutaneous fistula. A double-J catheter used as a ureteral stent during surgery was in place. A percutaneous pigtail nephrostomy was inserted on the 15th postoperative day but drainage continued. Antegrade pyelography demonstrated extravasation at the lower pole calyx. The double-J stent was removed on the 21st postoperative day, and a retrograde pyelogram showed no obstruction. Because drainage still was excessive on the 25th postoperative day, the fistula tract was embolized percutaneously with N-butyl cyanoacrylate, a tissue adhesive material. drainage ceased immediately after the procedure, and control pyelography confirmed no extravasation. The patient was discharged on the 28th postoperative day. The patient had no additional complications at 36-month follow-up.
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8/129. Fatal recurrent ureteroarterial fistulas after exenteration for cervical cancer.

    BACKGROUND: Ureteroarterial fistula (UAF) is a rare occurrence. It can be difficult to diagnose with a high mortality. We report a case of a recurrent UAF. CASE: A 38-year-old women diagnosed with cervical cancer had undergone pelvic exenteration for severe radiation-induced necrosis with a vesicovaginal and rectovaginal fistula after primary radiation therapy. hemorrhage into the urinary tract necessitated surgical intervention and vascular repair with a femoral-femoral bypass. Although these measures were effective, the patient died 6 months later following an acute hemorrhage into her conduit. Arteriogram revealed a second UAF. CONCLUSION: When urinary tract bleeding occurs in patients previously diagnosed with a gynecologic malignancy and treated with radiation therapy and extensive surgery with urinary diversion, UAF should be considered in the differential diagnoses.
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9/129. Rectourinary fistula with a narrow urethra.

    A rectourinary fistula is a common accompaniment of anorectal malformations (arm) in boys. Most boys pass urine normally after reconstruction and closure of the fistula, but a few have serious problems because of a narrow urethra. In our series, a narrow urethra was encountered in three types of male arm: 3 rectourethral fistulae, 4 rectovesical fistulae, and 6 H-fistulae. We have studied the diagnostic and therapeutic problems that a narrow urethra produces in patients afflicted with each of these malformations.
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10/129. Tube-flap for management of complex recto-urinary fistula with York Mason technique: a case report.

    Recto-urinary fistula results as a complication following trauma to the perinium and pelvis. These fistulas are difficult to treat and have a high recurrence rate due to the difficult surgical approach in repairing them. Both the transabdominal or transperineal approaches used in repairing these fistulas are difficult and provide only limited exposure to the fistula being repaired. In the case report, we present a patient with complex recto-urinary fistula due to trauma to the pelvis 20 years previously. In this patient we used the transphincteric York Mason approach to directly approach the fistula, followed by construction of a tube flap connecting the bladder and the urethra. The technique is simple, easy and the outcome has been excellent after 4 years of follow-up.
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