PD11-01 PELVIC RADIATION IS ASSOCIATED WITH URINARY FISTULAE REPAIR FAILURE AND NEED FOR PERMANENT URINARY DIVERSION

Abstract

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion II1 Apr 2015PD11-01 PELVIC RADIATION IS ASSOCIATED WITH URINARY FISTULAE REPAIR FAILURE AND NEED FOR PERMANENT URINARY DIVERSION Valary T. Raup, Jairam R. Eswara, Avory M. Heningburg, and Steven B. Brandes Valary T. RaupValary T. Raup More articles by this author , Jairam R. EswaraJairam R. Eswara More articles by this author , Avory M. HeningburgAvory M. Heningburg More articles by this author , and Steven B. BrandesSteven B. Brandes More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1090AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Enterourinary fistulae (EUF) and urinary-cutaneous fistulae (UCF) can be treated either primary closure or urinary diversion allowing the wound to heal by secondary intention. Primary repair often includes use of interposing omental, sliding, or muscle flap. Even after successful fistula repair, permanent urinary diversion can be required to manage persistent urinary incontinence. Here, we review our experience with non-muscle flap repairs of EUF and UCF. METHODS We retrospectively reviewed 86 patients who underwent treatment of EUF or UCF at a single institution between the years 1998–2013. Of these, 39 patients underwent fistula repair while 47 underwent either temporary to permanent urinary diversion. Outcomes measured included post-operative fistula closure, need for permanent urinary diversion, and urinary incontinence. RESULTS The mean age in our series was 59 years (21–87) at time of surgery with median follow-up of 20 months (1–137). Among patients who underwent surgical repair, radiation was associated higher rates of repair failure (p=0.0002), post-surgical incontinence (p<0.0001), and need for permanent urinary diversion (p=0.0076). Overall, 32 of the 44 radiated patients required permanent diversion (72%), compared to 3 of the 42 non-radiated patients (7%) (p<0.0001). CONCLUSIONS Patients who undergo pelvic radiation prior to EUF and UCF repairs are at higher risk for developing repair failure and post-surgical incontinence. A majority of patients eventually require permanent urinary diversion. Therefore, EUF and UCF repairs in radiated patients should be undertaken with caution, and patients should be counseled about the possibility of urinary diversion as primary therapy. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e251 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Valary T. Raup More articles by this author Jairam R. Eswara More articles by this author Avory M. Heningburg More articles by this author Steven B. Brandes More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...