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2.
Pan Afr Med J ; 33: 223, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692853

RESUMO

Ano-rectale malformations (ARM) are a spectrum of heterogeneous abnormalities in the development of the rectal canal. Its incidence is usually low and it is a little higher in some developing countries. Boys are more affected than girls and rectobulbar fistula associated with atresia of the anal canal is the most frequent disorder among them. We report the case of a 10-months old infant of male sex, whose mother lived in a mining area and had been complaining of fecaluria since the birth of her child. Physical examination showed fingerprint 1 cm below the intersection of the median raphe and the bi-ischiatic line. Paraclinical examinations showed no other associated malformation. Patient's management was based on anorectoplasty through abdominal and perineal approach with lower abdominoperineal reconstruction. In the post-operative period, the patient received antibiotic treatment and intravenous analgesia as well as dilations, which continued after discharge 2 weeks after surgery. No complications were observed and outcome was favorable.


Assuntos
Malformações Anorretais/cirurgia , Fístula Retal/cirurgia , Fístula Urinária/cirurgia , Analgésicos/administração & dosagem , Antibacterianos/administração & dosagem , Humanos , Lactente , Masculino , Fatores de Tempo
3.
Hinyokika Kiyo ; 65(7): 299-303, 2019 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-31501396

RESUMO

We report a case of right uretero-external iliac artery fistula. A 46-year-old woman diagnosed with left ovarian cancer with peritoneal dissemination underwent simple hysterectomy, bilateral adnexal removal, partial omentectomy and appendectomy. Sixteen months after the operation, a computed tomography scan showed right hydronephrosis due to the development of tumor within the pelvis. A ureteral stent was placed into the right ureter in order to preserve renal function. The ureteral stent was replaced at regular intervals. Five months after the ureteral stent placement, the patient was hospitalized urgently with gross hematuria. She was diagnosed with right uretero-external iliac artery fistula based on the angiographic examination that was conducted to detect the source of hemorrhage. She was treated successfully with endovascular stent grafting in the right external iliac artery. She has since shown no episode of hematuria.


Assuntos
Stents , Doenças Ureterais , Fístula Urinária , Fístula Vascular , Feminino , Humanos , Artéria Ilíaca , Pessoa de Meia-Idade , Doenças Ureterais/cirurgia , Fístula Urinária/cirurgia , Fístula Vascular/cirurgia
4.
Urology ; 134: 124-134, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31542459

RESUMO

OBJECTIVE: To assess the success of robot-assisted holmium laser debridement of the pubic symphysis for osteomyelitis of the pubic symphysis with associated urosymphyseal fistula. Traditionally, excision of the fistulous tract and concomitant cystectomy with urinary diversion and pubic symphyseal debridement has been done using an open approach. This paper presents patients who were successfully managed with this approach. METHODS AND MATERIALS: Between January 2007 and January 2018, all patients who underwent pubic symphyseal debridement with or without cystectomy were identified. We reviewed patients who underwent planned robot-assisted cystectomy with holmium laser debridement for osteomyelitis of the pubic symphysis as a result of urinary fistula. Data on clinical presentation, perioperative outcomes, and recurrence of urinary tract fistula and symptoms were collected. RESULTS: Twelve patients underwent holmium laser debridement of the pubic symphysis during robot-assisted cystectomy for urinary fistula. Eleven patients had prior radiation treatments for prostate cancer with all having failed prior conservative management. Median operative time was 270 minutes with median length of stay of 5 days. At last follow-up, 11 (91.7%) of patients had complete resolution of their urinary fistula at median follow-up of 29 months. No patients developed osteonecrosis of the bone or complications from their urinary diversion at last follow-up. CONCLUSION: Definitive surgical treatment with holmium laser debridement of the pubic symphysis with concomitant robot-assisted cystectomy and urinary diversion is a safe and durable approach to the complex problem of urinary fistula with pubic symphysis osteomyelitis.


Assuntos
Desbridamento/instrumentação , Lasers de Estado Sólido , Osteomielite/cirurgia , Sínfise Pubiana/cirurgia , Procedimentos Cirúrgicos Robóticos , Fístula Urinária/cirurgia , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica , Cistectomia/métodos , Seguimentos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Osteomielite/microbiologia , Sínfise Pubiana/diagnóstico por imagem , Sínfise Pubiana/microbiologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
5.
J Pediatr Surg ; 54(10): 2125-2129, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31079867

RESUMO

BACKGROUND: There are only a few publications in the medical literature reporting on complication rates in proximal hypospadias surgery, particularly with regard to long-term follow-up. METHODS: Over a 17.5-year period, we operated 100 patients with penoscrotal, scrotal and perineal hypospadias. Sixty-four had a single-stage repair, including 15 who received a buccal mucosa inlay "Snodgraft" repair. Thirty-six had a two-stage Bracka repair of which 19 received buccal or lower lip grafts and 17 had preputial grafts. Overall, 34 patients received buccal grafts. The median follow-up was eight years (range 1-16 years). Three patients were operated for residual chordee years later. RESULTS: Urethral fistulae occurred in a total of 26/100 (26.0%) cases, meatal stenosis in 16/100 (16.0%), wound breakdown in six (6.0%) and graft failure in one (1.0%). The fistula rate after the single-stage approach was 15/64 (23.4%), whereas it was 11/36 (30.6%) following two-stage repair (P = 0.4811). CONCLUSIONS: Proximal hypospadias remains a challenging condition to treat. It is possible to perform a single-stage repair in 64.0% of cases. This brings down the median number of operations to only two. Lower lip grafts were used in 34.0% but are now used in redo-surgeries only. Our fistula rate was 26.0% but has decreased significantly in recent years. LEVEL OF EVIDENCE: Level III.


Assuntos
Hipospadia/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Criança , Pré-Escolar , Prepúcio do Pênis/cirurgia , Humanos , Lactente , Masculino , Mucosa Bucal/transplante , Complicações Pós-Operatórias , Estudos Prospectivos , Escroto/cirurgia , Deiscência da Ferida Operatória , Resultado do Tratamento , Uretra/cirurgia , Doenças Uretrais/etiologia , Doenças Uretrais/cirurgia , Estreitamento Uretral/etiologia , Estreitamento Uretral/cirurgia , Fístula Urinária/etiologia , Fístula Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos
6.
Curr Urol Rep ; 20(6): 32, 2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31041546

RESUMO

Urinary tract fistulas represent a complex group of pathologies that present significant management challenges. While most such fistulas ultimately require definitive surgical management, compromised local tissue quality or other factors often render straightforward simple one layered closure challenging with a substantial risk of failure. Interpositional tissue flaps have become a mainstay of treatment in these circumstances, enabling the delivery of healthy tissue from other locations to the site of pathology. Herein, we present an overview of the assessment and management of complex urinary tract fistulas involving the reproductive and gastrointestinal organs, and the decision to utilize flaps. We review the underlying principles of tissue flaps and classify different types of flaps. We conclude with a discussion of the indications, advantages, disadvantages, and harvesting techniques for the most commonly utilized flaps in urinary tract fistula repair.


Assuntos
Gerenciamento Clínico , Retalhos Cirúrgicos , Fístula Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Humanos
7.
J Pediatr Surg ; 54(8): 1708-1710, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31076157

RESUMO

Recto-urethral fistulae are the most common finding in males born with an anorectal malformation (ARM). A high pressure distal colostogram is an important tool in visualizing the fistula, although the precise level at which the fistula communicates with the urethra may be difficult to interpret and is not reported in a uniform manner. This anatomy affects the surgical plan; determining the likelihood that the rectum is reachable via a posterior sagittal incision or better approached through the abdomen via laparoscopy or laparotomy helps counsel families and stratifies diagnoses for outcomes work. Herein we present a figure used at our Center to assist with correlating findings on the distal colostogram with the anatomic level of the recto-urethral fistula in males with anorectal malformations.


Assuntos
Fístula Retal/diagnóstico por imagem , Doenças Uretrais/diagnóstico por imagem , Fístula Urinária/diagnóstico por imagem , Malformações Anorretais/complicações , Humanos , Laparoscopia , Masculino , Planejamento de Assistência ao Paciente , Radiografia , Fístula Retal/etiologia , Fístula Retal/cirurgia , Doenças Uretrais/etiologia , Doenças Uretrais/cirurgia , Fístula Urinária/etiologia , Fístula Urinária/cirurgia
8.
Urology ; 131: e7-e8, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31132425

RESUMO

OBJECTIVE: To define clinical features and surgical management of urethro-cavernosal fistulas (UCF). METHODS: A literature search was performed using PubMed to identify publications with the key word urethro-cavernosal fistula. RESULTS: We herein describe surgical techniques and long-term outcomes for UCF repair. CONCLUSION: UCFs is a rare urological condition with only 9 cases reported to date. UCFs can be diagnosed with careful history, physical examination, and retrograde urethrography. Surgical management includes basic tenets of fistula repair, including adequate mobilization, tension-free but watertight approximation, multilayered closure with nonoverlapping suture lines, and maximal bladder drainage.


Assuntos
Fístula/etiologia , Fístula/cirurgia , Doenças do Pênis/etiologia , Doenças do Pênis/cirurgia , Uretra/lesões , Doenças Uretrais/etiologia , Doenças Uretrais/cirurgia , Fístula Urinária/etiologia , Fístula Urinária/cirurgia , Adulto , Humanos , Masculino , Fatores de Tempo , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
9.
Scand J Urol ; 53(2-3): 156-160, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31092116

RESUMO

Background: Pelvic radiotherapy causes tissue atrophy and fibrosis, leading to urinary tract dysfunction. Tissue ischaemia poses a significant surgical challenge. This study examined the urological sequelae of radiotherapy, types of reconstructive urological surgery (RUS) required and functional outcomes. Methods: A retrospective review was performed of all radiotherapy patients who underwent RUS at a tertiary centre between 2007-2017. Details including time from radiotherapy, pre-operative assessments, type of surgery performed and functional outcome were analysed. Results: Fifty-four patients were identified. The primary malignancy was cervical (32), colorectal (9) and other urogenital/metastatic origins in the remaining cases. Mean time between radiation and RUS was 13 years. Sixty-nine reconstructive surgeries were performed. Twenty-two patients had fistulae, but only 27% were closed and 73% ended with urinary diversion. Eighteen had ureteric strictures, with 56% having associated bladder dysfunction. Twelve (67%) patients had RUS, of whom 83% required bowel interposition, and 33% primary diversion. Nine of 24 patients with contracted bladders were reconstructed and eight remain functionally continent. Renal function stabilised or improved in 87%. Nine patients (17%) had Clavien 3 or 4 complications. Conclusions: A variety of complex, major RUS were required. In 61%, urinary diversion was necessary, with radiotherapy fistulae being a particular challenge and closed in only a third. In total, 37% of patients were reconstructed achieving functional continence and restoration of upper-tract drainage with renal function preservation. This surgery was at a cost of a re-intervention rate of 28% and significant morbidity in 17%. RUS in the radiotherapy field should be performed in centres with experience.


Assuntos
Lesões por Radiação/cirurgia , Radioterapia/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Doenças Ureterais/cirurgia , Doenças da Bexiga Urinária/cirurgia , Fístula Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/radioterapia , Constrição Patológica , Contratura/etiologia , Contratura/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Ovarianas/radioterapia , Pelve , Lesões por Radiação/etiologia , Estudos Retrospectivos , Retalhos Cirúrgicos , Resultado do Tratamento , Doenças Ureterais/etiologia , Neoplasias Uretrais/radioterapia , Doenças da Bexiga Urinária/etiologia , Derivação Urinária/métodos , Fístula Urinária/etiologia , Neoplasias do Colo do Útero/radioterapia
10.
Arch Esp Urol ; 72(4): 428-435, 2019 May.
Artigo em Espanhol | MEDLINE | ID: mdl-31070140

RESUMO

OBJECTIVE: This paper describes our initial experience with laparoscopic ureteroneocystostomy in two patients with distal ureter lesions following gynaecological surgery (hysterectomy). Furthermore, we review the evidence on the incidence, prevention, and management of urinary tract injuries that occur during laparoscopic gynaecological surgery. METHOD: Two patients with iatrogenic lower ureteral injuries during hysterectomy leading to ureterovaginal fistula underwent laparoscopic ureteroneocystostomy with a psoas hitch. RESULTS: The procedures were successfully performed without any conversion. No intraoperative or postoperative complications were noted. Our minimally invasive approach has yielded successful results, similar to those achieved through open surgical repair. CONCLUSION: Laparoscopic ureteroneocystostomy with a psoas hitch for ureterovaginal fistula secondary to hysterectomy is a safe and feasible option for patients with gynecologic distal ureteral injury, with excellent results and low morbidity.


Assuntos
Laparoscopia , Ureter , Doenças Ureterais , Fístula Urinária , Fístula Vaginal , Feminino , Humanos , Histerectomia , Doenças Ureterais/cirurgia , Fístula Urinária/cirurgia , Fístula Vaginal/cirurgia
11.
Urol Int ; 103(2): 218-222, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30970368

RESUMO

OBJECTIVES: To highlight the transvaginal route as an excellent approach for repair of a simple trigonal, supra-trigonal vesico-vaginal and urethrovaginal fistulae without compromising on the successful patient outcomes. We also determine factors affecting outcomes in such patients. MATERIALS AND METHODS: A retrospective analysis was carried out on 58 patients with simple trigonal, supra trigonal and urethrovaginal fistula who underwent transvaginal repair in the last 10 years. Simple fistulas were defined as fistula less than 3 cm in size or recurrent fistulae less than 1.5-2 cm in size and located either supra-trigonally (above the bar of mercier) or sub-trigonally (below the bar of mercier) as determined by cystoscopy. RESULTS: Obstetric cause, due to obstructed labour, was the most common cause of fistula formation (68.96%), while remaining (29.31%) were attributed to hysterectomy. Primary fistulae were found in 68.9% of patients and recurrent fiistulae in 31.1% patients. The mean age of patients was 33.4 years. Average fistula size was 1.5 cm. The success rate of primary operation was 84.12% (50/58). On using a multivariate regression model, the underlying aetiology (OR 2.2), fistula location (OR 2.5) and history of previous repair (OR 2.4) were found to be significant factors affecting outcome. CONCLUSION: The transvaginal approach is less invasive and achieves comparable success rates as compared to other methods of vesico-vaginal fistula repair. This surgery with Foley catheter has a high success rate with reduced morbidity. We postulate that vaginal approach should be preferred over abdominal approach for repair of all vaginally accessible vesico vaginal fistulae, both of obstetrical and gynaecological origin.


Assuntos
Doenças Uretrais/cirurgia , Fístula Urinária/cirurgia , Fístula Vaginal/cirurgia , Fístula Vesicovaginal/cirurgia , Adulto , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos/métodos , Vagina
12.
Pediatr Radiol ; 49(5): 609-616, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30666353

RESUMO

BACKGROUND: Recently, it has been reported that anorectal malformation with rectourethral fistula in male neonates can be managed by primary neonatal reconstruction without colostomy. To prevent urethral injury during anorectoplasty, the fistula's location is important. To date, the use of voiding cystourethrograms to determine the presence and location of fistulas in neonates with anorectal malformations has not been studied. OBJECTIVE: To compare the accuracy of ultrasound (US) and voiding cystourethrogram for determining the presence and location of fistulas in neonates with anorectal malformation. MATERIALS AND METHODS: We included 21 male neonates with anorectal malformation with rectourethral fistula (n=16), rectovesical fistula (n=1) or no fistula (n=4) who underwent US and voiding cystourethrogram preoperatively on the day of surgery. Fistula imaging was classified into three grades (0-2), and grades 1-2 were considered fistula positive. We compared the imaging-based location of the fistula with surgical findings. RESULTS: US performed significantly better than voiding cystourethrogram for determining the presence of fistulas (area under the receiver operating characteristic curve, 0.90 vs. 0.71, respectively; P=0.044) (diagnostic accuracy 85.7%, 95% confidence interval [95% CI] 63.7-97.0% and 52.4%, 95% CI 29.8-74.3%, respectively). In cases with fistulas detected by either modality, the accuracy of locating the fistula by US was 50.0% (95% CI 24.7-75.3%) and by voiding cystourethrogram was 100% (95% CI: 59.0-100%). CONCLUSION: US accurately detected, but did not accurately locate, fistulas in neonates with anorectal malformation. When planning primary neonatal reconstruction of anorectal malformation without colostomy, voiding cystourethrogram could provide additional information about fistula location.


Assuntos
Malformações Anorretais/diagnóstico por imagem , Cistografia/métodos , Fístula Retal/diagnóstico por imagem , Ultrassonografia/métodos , Doenças Uretrais/diagnóstico por imagem , Fístula Urinária/diagnóstico por imagem , Malformações Anorretais/cirurgia , Humanos , Recém-Nascido , Masculino , Fístula Retal/cirurgia , Estudos Retrospectivos , Doenças Uretrais/cirurgia , Fístula Urinária/cirurgia
13.
Int Urogynecol J ; 30(5): 839-841, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30685786

RESUMO

INTRODUCTION AND HYPOTHESIS: A urethrovaginal fistula is a possible rare complication of tension-free vaginal tape procedures. Surgical management of these fistulas is sometimes complicated, and failure can occur. The operation is difficult when the defect between the urethra and the vagina is larger or scarred, so surgical intervention and the preferred technique are controversial. METHODS: The patient was referred to our department, where the first operation was performed to address the urethrovaginal fistula by the transvaginal and transabdominal approach with interposed omentum. This initial repair failed, resulting in a large urethrovaginal fistula with minimal redundant anterior vaginal wall to provide a tension-free closure. This video presentation describes the second operation-transvaginal repair of a large recurrent urethrovaginal fistula using the skin island flap technique. RESULTS: The video of the procedure shows how to address a recurrent urethrovaginal fistula by employing a skin flap. An examination during the patient's follow-up visit 3 months later revealed excellent healing and persistent stress urinary incontinence (SUI). Six months after the fistula repair, the patient underwent a bulking agent procedure. CONCLUSIONS: The skin island flap procedure allowed the larger defect to heal, though it did not address the SUI, which was later treated by application of a bulking agent.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/métodos , Slings Suburetrais/efeitos adversos , Fístula Urinária/cirurgia , Fístula Vaginal/cirurgia , Idoso , Feminino , Humanos , Recidiva , Fístula Urinária/patologia , Incontinência Urinária por Estresse/cirurgia , Fístula Vaginal/patologia
14.
Tech Coloproctol ; 23(1): 43-52, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30604248

RESUMO

BACKGROUND: The aim of this study was to evaluate the effectiveness of gracilis muscle transposition (GMT) to treat recurrent anovaginal, rectovaginal, rectourethral, and pouch-vaginal fistulas in patients with inflammatory bowel disease (IBD). METHODS: A retrospective study was conducted in patients with IBD who had GMT performed by a single surgeon between 2000 and 2018. Follow-up data regarding healing rate, complications, additional procedures, and stoma closure rate was collected. RESULTS: A total of 30 women and 2 men had GMT. In all patients fistula was associated with Crohn's disease. In 1 female patient, contralateral gracilis transposition was required after a failed attempt at repair. The primary healing rate was 47% (15/32) and the definitive healing rate (healed by the time of data collection and after secondary procedures) was 71% (23/32). Additional surgical procedures due to fistula persistence or recurrence were performed on 17 patients (53%).At least 7 patients (21%) suffered complications including one wound infection with ischemia of the gracilis muscle. Stoma closure was successful in 18 of 31 cases of patients with stoma (58% of the patients). CONCLUSIONS: GMT for the treatment of recurrent and complex anorectal fistulas in patients with IBD patient is eventually successful in almost 2/3 of patients.


Assuntos
Doença de Crohn/complicações , Fístula/cirurgia , Músculo Grácil/transplante , Fístula Urinária/cirurgia , Fístula Vaginal/cirurgia , Adulto , Feminino , Fístula/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fístula Retal/etiologia , Fístula Retal/cirurgia , Fístula Retovaginal/etiologia , Fístula Retovaginal/cirurgia , Recidiva , Estudos Retrospectivos , Retalhos Cirúrgicos , Resultado do Tratamento , Doenças Uretrais/etiologia , Doenças Uretrais/cirurgia , Fístula Urinária/etiologia , Fístula Vaginal/etiologia
15.
J Pediatr Surg ; 54(3): 471-478, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29778544

RESUMO

PURPOSE: To identify anatomical aberrations following PSARP procedure by using MRI, while correlating MRI findings to clinical outcome. PATIENTS AND METHODS: Between January 2014 and December 2017, we conducted our study on male patients with rectourethral fistula who underwent PSARP. Postoperative pelvic MRI studies were performed and correlated to their clinical continence scores (Rintala, and Krickenbeck classification). RESULTS: The study included 31 patients. Fourteen patients were retrieved from the hospital records and accepted to participate in the study; while the remaining 17 were collected from the fecal incontinence clinic. Their age ranged from 40 to 156 months (mean 83) We divided patients in the study into two groups according to their Rintala continence scores: (Group A) 15 patients with low scores (10 or less); and (Group B) 16 patients with higher scores (more than 10). We detected wider pelvic hiatus (hiatus/PC ratio) and more obtuse anorectal angle in group A than B. CONCLUSION: Several anatomical alterations can be detected by MRI following the PSARP procedure that include abnormalities in the striated muscle sphincter (attenuation/deficiency), deviated neorectum, and presence of excessive perirectal fat. A widened pelvic hiatus and/or obtuse anorectal angle may correlate with poor fecal continence in these patients. LEVEL OF EVIDENCE: This is a case control study (level III evidence).


Assuntos
Incontinência Fecal/etiologia , Imagem por Ressonância Magnética/métodos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Fístula Retal/cirurgia , Doenças Uretrais/cirurgia , Fístula Urinária/cirurgia , Adolescente , Canal Anal/diagnóstico por imagem , Canal Anal/patologia , Canal Anal/cirurgia , Estudos de Casos e Controles , Criança , Pré-Escolar , Defecação , Humanos , Lactente , Masculino , Procedimentos Cirúrgicos Reconstrutivos/métodos , Fístula Retal/complicações , Reto/cirurgia , Resultado do Tratamento , Uretra/diagnóstico por imagem , Uretra/patologia , Uretra/cirurgia , Doenças Uretrais/complicações , Fístula Urinária/complicações
16.
Urologia ; 86(1): 39-42, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30118403

RESUMO

INTRODUCTION:: Entero-neovesical fistula is a rare complication after radical cystectomy and orthotopic ileal bladder substitution. Typical presenting symptoms are faecaluria, pneumaturia, recurrent urinary tract infections and abdominal pain. Risk factors include history of pelvic radiation, chemotherapy and abdominal surgery, as well as diverticular colonic disease, inflammatory bowel disease and traumatic pelvic injury. The paucity of cases reported in the literature makes the management of this threatening complication very challenging. Conservative treatment has only anecdotally been reported. CASE DESCRIPTION:: We describe two cases of entero-neovesical fistula with different presentation, which both required an immediate surgical treatment. The former patient was admitted to the emergency room with faecaluria, complete urinary incontinence and fever 2 years after radical cystectomy, and a fistula between the Y-shaped neobladder and the bowel anastomosis was detected. He had previously undergone chemotherapy because of tumour progression. Undiversion into an ileal conduit was required. The latter patient presented with faecaluria 20 days after an uneventful radical cystectomy, and a fistula between the Vescica Ileale Padovana neobladder and the sigmoid was documented. Treatment included resection of the sigmoid with several small diverticula, temporary ileostomy and closure of the neobladder fistula. CONCLUSION:: Conservative treatment of entero-neovesical fistula can be attempted only in patients with small openings in the small bowel and no systemic symptoms. In all other cases, surgical treatment with bowel resection and either closure of the neobladder opening or undiversion should be the preferred option.


Assuntos
Cistectomia , Íleo/cirurgia , Complicações Pós-Operatórias/cirurgia , Bexiga Urinária/cirurgia , Derivação Urinária , Fístula Urinária/cirurgia , Idoso , Humanos , Masculino , Pessoa de Meia-Idade
18.
Int Urogynecol J ; 30(4): 537-544, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30327850

RESUMO

INTRODUCTION AND HYPOTHESIS: Vaginal apical suspension is essential for the surgical treatment of pelvic organ prolapse (POP). We aim to evaluate whether the method of apical repair is associated with different re-operation rates for POP recurrence or surgical complications. METHODS: Population-based, retrospective cohort study of all Ontario women receiving primary apical POP repairs from 2003 to 2015. Primary exposure was the method of apical POP repair. Primary outcome was re-operation for recurrent POP, and secondary outcomes were surgical procedures for genito-intestinal (GI) or genitourinary (GU) complications, fistula repair, and mesh revision or removal. RESULTS: Forty-three thousand four hundred fifty-eight women were included. Overall, the number of mesh-based apical repairs decreased over time, while the number of native-tissue repairs slightly increased (p < 0.001). Multivariable Cox proportional hazards (Cox PH) analysis demonstrated a significant increase in repeat POP operations for transvaginal mesh apical repairs (adjusted HR 1.28 [95% CI: 1.10-1.48]), but not in abdominal mesh repairs (adjusted HR 0.96 [95% CI: 0.81-1.13]) compared with vaginal native tissue apical repairs. Overall risk of repeat surgery for fistulas or GI and GU complications remained low (< 0.5%). Risk of mesh removal or revision was 11.5-11.9%, with no difference between abdominal versus vaginal mesh on multivariable analysis (adjusted HR 0.99 [95% CI: 0.78-1.26]). CONCLUSIONS: Re-operation for recurrent POP is highest in transvaginal mesh apical repairs; however, this risk did not differ between abdominal mesh and vaginal native tissue apical repairs. GI and GU re-operations are rare. There is no difference in mesh removal or revision rates between abdominal and vaginal mesh repairs.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Prolapso de Órgão Pélvico/cirurgia , Reoperação/estatística & dados numéricos , Telas Cirúrgicas/estatística & dados numéricos , Vagina/cirurgia , Abdome/cirurgia , Idoso , Remoção de Dispositivo , Feminino , Fístula/etiologia , Fístula/cirurgia , Doenças dos Genitais Femininos/etiologia , Doenças dos Genitais Femininos/cirurgia , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Procedimentos Cirúrgicos em Ginecologia/tendências , Humanos , Fístula Intestinal/etiologia , Fístula Intestinal/cirurgia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Recidiva , Estudos Retrospectivos , Telas Cirúrgicas/efeitos adversos , Fístula Urinária/etiologia , Fístula Urinária/cirurgia
19.
J Pediatr Surg ; 54(3): 612-615, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30297116

RESUMO

Acquired urethrovaginal fistulae and urethral atresia are rare findings in pediatric patients, but have been described in adult patients related to trauma or iatrogenic injury. Little exists in the published literature to guide management of such conditions in children, but lessons learned from congenital causes can help. Herein we discuss the preoperative evaluation and management of a child with an acquired urethrovaginal fistula and urethral atresia likely related to in utero compression from an intrapelvic sacrococcygeal teratoma and provide several images detailing the complex anatomy.


Assuntos
Região Sacrococcígea/patologia , Teratoma/complicações , Doenças Uretrais/cirurgia , Fístula Urinária/cirurgia , Fístula Vaginal/cirurgia , Endoscopia/métodos , Feminino , Humanos , Lactente , Cuidados Pré-Operatórios/métodos , Região Sacrococcígea/cirurgia , Teratoma/cirurgia , Doenças Uretrais/complicações , Fístula Urinária/complicações , Anormalidades Urogenitais/diagnóstico , Anormalidades Urogenitais/cirurgia , Fístula Vaginal/complicações
20.
Pediatr Surg Int ; 35(2): 247-251, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30406836

RESUMO

AIM: It has long been considered surgical dogma that the length of the shared common wall (CW) between a fistula and the urethra in males with anorectal malformation (ARM) and rectourethral bulbar fistula (RUBF) is considerably longer than in males with ARM and rectourethral prostatic fistula (RUPF). This belief has led surgeons who perform laparoscopic-assisted anorectoplasty (LAARP) for RUPF to avoid LAARP for RUBF for risk of potential injury to the urethra or incomplete removal of the fistula. In this study, we compared CW between RUBF and RUPF using distal colostography (DCG) and direct intraoperative measurements. METHODS: DCG of rectourethral fistula patients (n = 63; RUBF: n = 44; RUPF: n = 19) were used to measure CW retrospectively. Results were expressed as a ratio of the height of L4; i.e., CW:L4. If less than 0.7, the CW was classified as being "short"; if 0.71-1.4, as being "medium"; and if greater than 1.41, as being "long". CW that could not be measured was classified as indeterminate. 24 of these patients also had CW measured intraoperatively during LAARP as previously described. The results obtained using both techniques were also compared. RESULTS: Surprisingly, CW:L4 in RUBF patients was short in 47.7%, medium in 27.3%, long in 20.5%, and indeterminate in 4.5% on DCG, equivalent to mean lengths of 7 mm, 8.5 mm, and 10.3 mm obtained using direct intraoperative measurement for short, medium, and long CW:L4 categories, respectively. CW:L4 in RUPF was short in 73.6%, medium in 10.5%, and long in 5.2% on DCG, while mean intraoperative measurements were 5 mm, 7 mm, and 10 mm, respectively. Differences in CW measured intraoperatively were not significantly different between RUBF and RUPF (p = NS). CONCLUSION: From our findings, 47.7% of CWs in RUBF were short using two independent methods, with only 20.5% being long. Thus, LAARP should be considered actively for treating selected RUBF cases and not be excluded on the basis of CW length.


Assuntos
Malformações Anorretais/diagnóstico por imagem , Malformações Anorretais/cirurgia , Doenças Uretrais/diagnóstico por imagem , Doenças Uretrais/cirurgia , Fístula Urinária/diagnóstico por imagem , Fístula Urinária/cirurgia , Humanos , Masculino , Doenças Prostáticas/diagnóstico por imagem , Doenças Prostáticas/cirurgia , Fístula Retal/diagnóstico por imagem , Fístula Retal/cirurgia , Estudos Retrospectivos , Doenças Uretrais/patologia
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