MP78-15 MANAGEMENT AND OUTCOMES OF ILEAL POUCH-URETHRAL FISTULAS

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP78-15 MANAGEMENT AND OUTCOMES OF ILEAL POUCH-URETHRAL FISTULAS João Pedro Emrich Accioly, Marianna Maspero, Hanson Zhao, Roger K. Khouri, Olga Lavryk, Kenneth W. Angermeier, Tracy Hull, and Hadley M. Wood João Pedro Emrich AcciolyJoão Pedro Emrich Accioly More articles by this author , Marianna MasperoMarianna Maspero More articles by this author , Hanson ZhaoHanson Zhao More articles by this author , Roger K. KhouriRoger K. Khouri More articles by this author , Olga LavrykOlga Lavryk More articles by this author , Kenneth W. AngermeierKenneth W. Angermeier More articles by this author , Tracy HullTracy Hull More articles by this author , and Hadley M. WoodHadley M. Wood More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003355.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Fistulas may develop following ileal pouch anal anastomosis (IPAA), but urinary tract involvement in this setting is rare. We thus aim to describe our experience with the management of ileal pouch-urethral fistulas (IPUF) following restorative proctocolectomy with IPAA. METHODS: We retrospectively identified patients with documented IPUF managed at our institution from a urethral fistula cohort through keywords and procedure codes. In a retrospective medical record review, we obtained demographic, clinical and operative data, including diagnostic methods, individual management strategies and outcomes and described our findings. RESULTS: We identified thirteen patients with a diagnosis of IPUF managed from 2005–2022. Median age at IPAA was 29 years (range 11–53). Indications for IPAA included familial adenomatous polyposis (n=3) and ulcerative colitis (n=10). Interval events included IPAA dilations (n=5) and dual radiation therapy for prostate cancer (n=2). Median time from IPAA to fistula diagnosis was 15 years (range 0.5–38.5). Initial management consisted of urinary diversion with either suprapubic tube (n=6) or Foley catheter (n=1) and fecal diversion with either loop (n=8) or end ileostomy (n=3); five had dual urinary/fecal diversion. Four patients experienced resolution with either urinary (n=2) or fecal (n=2) diversion alone. Eight patients eventually required pouch excision and end ileostomy, of which seven underwent concomitant urethral repair. Gracilis muscle interposition was employed in addition to primary closure in five patients. Only one patient successfully underwent re-do IPAA. With a median follow-up of 4 years (range 0.3–13 years), all patients had resolution of their fistulas without recurrence. CONCLUSIONS: IPUFs are an uncommon complication of IPAA. In this cohort, all patients had urinary tract preservation, but in most instances, permanent fecal diversion was necessary. These results can help guide management of this complex issue. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1137 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information João Pedro Emrich Accioly More articles by this author Marianna Maspero More articles by this author Hanson Zhao More articles by this author Roger K. Khouri More articles by this author Olga Lavryk More articles by this author Kenneth W. Angermeier More articles by this author Tracy Hull More articles by this author Hadley M. Wood More articles by this author Expand All Advertisement PDF downloadLoading ...