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Pelvic Fistulas in Urology

Successful closure of a bladder neck fistula complicated by urethral and vaginal stenosis, using oxidized cellulose (Surgicel) for reinforcement.
Mittal S, Sharma JB, Gupta N
Int Urogynecol J Pelvic Floor Dysfunct 2005 Nov 5;:1-3.

We describe a case of a bladder neck fistula in a 25-year-old lady presenting with true urinary incontinence, vaginal constriction and induration, with vaginal length reduced to only 1.5 cm. There was an 8-mm fistula involving upper urethra and bladder neck, with fibrosis all around. Using Schuchardt incision, the fistula was reached and mobilization tried. As there was less available tissue, a 3x2-cm layer of oxidized cellulose was stitched between the bladder and the vaginal mucosa for reinforcement and to achieve a watertight closure of fistula.

Urinary fistulas following external radiation or permanent brachytherapy for the treatment of prostate cancer.

Chrouser KL, Leibovich BC, Sweat SD, Larson DW, Davis BJ, Tran NV, Zincke H, Blute ML.
J Urol 2005 Jun;173(6):1953-7.

PURPOSE: Prostate cancer (PCa) radiotherapy (RT), including brachytherapy, may lead to significant morbidity, including urinary
fistulas. If conservative measures fail, urinary and/or fecal diversion is often required. In this study we examined a series of patients with fistulas that developed after pelvic radiation therapy and explored potential predisposing factors and treatment recommendations for refractory fistulas. MATERIALS AND METHODS: Patients were identified who received radiation therapy for PCa between 1977 and 2002, and subsequently had a fistula to the urinary tract. Patients were excluded who had diverticulitis, inflammatory bowel disease, a history of recent radical retropubic prostatectomy (possible iatrogenic etiology) or cancer in the excised fistula. Data were extracted from patient charts, mailed questionnaires and outside records. RESULTS: A total of 51 patients were identified with a history of radiation for PCa who subsequently had a urinary fistula. Of 20 patients meeting inclusion criteria 30% received external beam RT alone, 30% received brachytherapy and 40% received combined external beam RT/brachytherapy. Most fistulas (80%) were from the rectum to the urinary tract with an average diameter of 3.2 cm. Of patients with rectal fistulas 81% had a history of rectal stricture, urethral stricture, rectal biopsy, rectal argon beam therapy or transurethral prostate resection after radiation. All patients with rectourethral fistulas who achieved symptomatic resolution required urinary and fecal diversion. CONCLUSIONS: Conservative treatment is generally ineffective in the management of large urinary fistulas. Surgical intervention offers symptomatic relief and improved quality of life in most patients.

Scrotal dartos flap for the prevention of the urethrocutaneous fistula on hypospadias urethroplasty.
Hayashi Y, Kojima Y, Kurokawa S, Mizuno K, Nakane A, Kohri K
Int J Urol 2005 Mar;12(3):280-3.

Background: Urethrocutaneous fistula is a common complication of urethroplasty for severe hypospadias, even when a microsurgical technique is applied. Patients and methods: From June 2001 to July 2003, we applied the scrotal dartos flap wrapping technique to prevent the occurrence of urethrocutaneous fistula in 14 patients with hypospadias. Results: Hypospadias was repaired without fistula formation in all but one patient, who developed a tiny fistula which was later closed successfully by a simple procedure. Conclusions: We recommend the scrotal dartos wrapping technique for covering the neourethra with a well-vascularized flap because of fewer complications, although the procedure to obtain the vascularized flap may take longer.

Urethrovasocutaneous fistula in a case of anterior urethral stricture.
Singh SK, Rai RS, Sharma SK
Urol Int 2005;74(1):86-8.

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.