Ureterocutaneous Fistula Research Articles

A Case of Metastatic Skin Tumor Arising from Bilateral Ureterocutaneous Fistula Associated with Bladder Cancer

A Case of Metastatic Skin Tumor Arising from Bilateral Ureterocutaneous Fistula Associated with Bladder Cancer

Ureterocutaneous Fistula in the Setting of Recurrent Gluteal Abscesses: A Case Report

Ureteral fistulas are a rare occurrence that can arise from iatrogenic trauma, radiation, malignancy, and inflammation. Treatment options of urinary tract fistulas are handled on a case-by-case basis, and can necessitate a surgical approach. The authors present the case of an 85-year-old female patient with a ureterocutaneous fistula, where conservative management with percutaneous nephrostomy is a viable alternative to surgical intervention.

Pyelonephritic end-stage kidney and ureterocutaneous fistula in a Shetland pony.

A 12-y-old Shetland Pony was presented with a mucus-secreting fistula in the right paralumbar fossa. Surgery was performed to unravel the origin of the fistula. The horse died under anesthesia and was forwarded to autopsy. The right kidney was markedly atrophic and fibrotic, consistent with unilateral end-stage kidney. The right ureter was markedly thickened, but with luminal continuity leading into the urinary bladder where a partial obstruction caused by nodular para-ureteral fat necrosis was evident. The lumen of the cutaneous fistula was continuous with the right ureter; therefore, we diagnosed the lesion as a ureterocutaneous fistula. Anomalies of the ureter are uncommon, and ureterocutaneous fistula formation in equids has not been reported previously to our knowledge.

Living versus deceased kidney transplantation: Comparison of complications.

It is assumed that the outcome of kidney transplantation from living donors is more favorable than deceased donors. However, over the years there has been an overall improvement in transplant survival from both living and deceased donors. In this article we have evaluated and compared the most recent results in living and deceased donor kidney transplantations. Four hundred and forty six patients underwent kidney transplantation in our center from September 2009 to March 2014. The patients divided in two groups living (group A) and deceased (group B) donor transplantation groups. The patients were followed until September 2016. Acute rejection, graft survival, delayed graft function, renal artery thrombosis, graft nephrectomy, ureterocutaneous fistula, postoperative hypertension, mortality, hospital stay, hyperlipidemia, post transplantation diabetes and lymphocele rate measured and compared in two groups. Most variables were not different between the two groups except lymphocele and delayed graft function. Lymphocele was more prevalent in group A (13.8% vs 3.1%, p-value = 0.02) and delayed graft function results were more desirable in living donor transplantation group (group B). Although, delayed graft function was less common in transplantation from living donors, short, and long term graft survival was not significantly different in this study.

A Case of Squamous Cell Carcinoma Occurring at the Ureterocutaneous Fistula as Metachronous Quadruple Cancers

A Case of Squamous Cell Carcinoma Occurring at the Ureterocutaneous Fistula as Metachronous Quadruple Cancers

Spontaneous Ureterocutaneous Fistula Secondary to Obstructed Ureteric Stone

We present a unique case of ureterocutaneous fistula secondary to an obstructed ureteric stone. A fistulagram confirmed a communication between right flank and the proximal ureter. Ureterocutanoues fistula in the absence of trauma, iatrogenic causes, granulomatous infection, or malignancy is highly unusual.

Iatrogenic ureter cutaneous fistula and incisional hernia following laparotomy - case report

Ureteric injuries are known and preventable complications that may follow pelvic surgeries. These injuries are commonly ligation of the distal ureters and are frequently missed intraoperatively. Symptoms typically comprise of post-operative flank pain, fever, and flank swelling from urinary tract obstruction or urinoma. We hereby present a rare case of iatrogenic ureteric injury, ureterocutaneous fistula, and an associated incisional hernia in a middle-aged woman who had ovarian cyst excision.

A Case of Ureterocutaneous Fistula After Nephrectomy

A Case of Ureterocutaneous Fistula After Nephrectomy

Post‐renal transplant ureterocutaneous fistula: Management of complications and literature review

Ureterocutaneous fistula is a major complication following renal transplantation. Timely management can minimise patient and graft comorbidities. We reported three cases of post‐renal transplant ureterocutaneous fistula. Two of them were successfully repaired with Boari flap and one of them were repaired with ileal interposition. Literature review revealed that double‐J stent insertion during renal transplant can significantly reduce post‐transplant major ureteric complications (MUC). Evidence did not show any difference in MUC between early removal of stent (≤14 days) and late removal (>14 days). Yet incidence of UTI could be reduced in early stent removal.

Calculus pyelonephritis associated with ureterocutaneostomy.

A 79-year-old woman with a history of total hysterectomy for cervical cancer with ureterocutaneostomy presented with high fever. She had tenderness and a hard lump around the ureterocutaneostomy site. Computed tomography scan revealed 1.5 cm ureteral calculus in ureterocutaneous fistula (Fig. 1A) associated with bilateral hydronephrosis (Fig. 1B) and we performed a transureteral stent insertion. Blood culture grew methicillin-sensitive Staphylococcus aureus (MSSA), Haemophilus parainfluenzae, Veillonella species and Bacteroides fragilis and urine culture revealed Escherichia coli, MSSA, and Enterococcus faecalis. The patient’s clinical signs and symptoms gradually improved with ampicillin/sulbactam. Patients with urinary diversions including ureterocutaneostomy and iliac conduits are at increased risk of urolithiasis (1), which can cause sepsis, pyelonephritis, and renal insufficiency (2). Since most patients become colonized with a multitude of bacteria including Enterobacteriaceae and skin flora such as Staphylococcus aureus and Streptococcus spp., we should empirically treat with broad-spectrum antimicrobials until the culture results are available. Early diagnosis and urological intervention are required because it can be life-threatening with delayed treatment.

A CASE THAT TS-1+CDDP THERAPY WAS EFFECTIVE FOR BLADDER PRIMARY SIGNET RING CELL ADENOCARCINOMA

Since we experienced a case that S-1+Cisplatin (CDDP) therapy was effective for bladder primary signet ring cell adenocarcinoma of pT4N0M0, we report here the time course of its pathophysiology and the treatment of that patient, and discuss the justification of the chemotherapy for the T4 case with the comparison of the previous cases. The present case is a 66 years old man. Because he was aware of the urinary frequency and the sense of incongruity at abdominal region for approximately three months, he visited our hospital for the consultation of his symptoms in July, 2015. The anterior wall showed a torose lesion by cystoscopy from the left sidewall, and we found the histopathology signet ring cell adenocarcinoma after transurethral resection of the bladder tumor. As a result of thorough investigation of thoracic abdominal CT, whole body PET-CT and endoscopy of the upper gastrointestinal tract, we diagnosed it as bladder primary signet ring cell adenocarcinoma with cT3N0M0. Consequently, we tried total cystectomy in August, 2015, however both bladder and pelvic wall were adhered strongly each other; we gave up the total cystectomy and changed the strategy to the urinary diversion by bilateral ureterocutaneous fistula. A biopsy of the adhesion site of the right pelvic wall showed the invasion of the signet ring cell adenocarcinoma, which enabled us to diagnose as pT4bN0M0. Therefore, we performed the chemotherapy with the S-1+CDDP for 12 courses, 16 months from August, 2015 after the surgery. After the initiation of the chemotherapy, the tumor marker was tended to decrease for eight months, but turned to increase thereafter. Because there was no evidence for neither distant nor lymph node metastases of tumor revealed by CT and the MRI, we diagnosed it as Stable Disease at least by CT and MRI examinations for 16 months. The major side-effects were not found during the strengthened chemotherapy without the recurrence until January, 2017. Since this case is very rare, we report the time courses and treatment strategy of a patient with bladder primary signet ring cell adenocarcinoma.

Salvage urethroplasty using skin grafts for previously failed long-segment urethral strictures

The aim of this study was to describe a technique using full-thickness skin grafts (FTSGs) from different parts of the body for salvage urethroplasties and the present outcomes. A total of 24 men underwent urethroplasties for strictures averaging 7.7 cm (range, 5–17 cm) in length, using FTSGs from the inner arm, inner thigh, or abdominal skin. Each of these cases had at least one failed urethroplasty. Twenty-four patients underwent surgery for 26 urethral strictures, with a mean follow-up period of 23.2 (5–44) months and a mean operation time of 140 (115–180) minutes. Reconstruction of the urethra with skin grafting was successful in 18 out of the 26 procedures during the first attempt (69%). A “redo” skin grafting was performed for the eight failed cases, with four successful procedures (50%). Overall, the success rate was 84% (22 out of 26 urethral strictures); however, the failed cases developed abscesses and later, ureterocutaneous fistulas. No hair formation from the skin grafts was seen. Skin grafts provide useful alternative graft sources for previously failed long-segment urethral strictures in which the buccal mucosae are not available or are insufficient for salvage urethroplasties with an acceptable success rate.

Robotic management of genitourinary injuries from obstetric and gynaecological operations: a multi-institutional report of outcomes.

To evaluate the utility of robotic repair of injuries to the ureter or bladder from obstetrical and gynaecological (OBGYN) surgery A retrospective review of all patients from four different high-volume institutions between 2002 and 2013 that had a robot-assisted (RA) repair by a urologist after an OBGYN genitourinary injury. Of the 43 OBGYN operations, 34 were hysterectomies: 10 open, 10 RA, nine vaginally, and five pure laparoscopic. Nine patients had alternative OBGYN operations: three caesarean sections, three oophorectomies (one open, two laparoscopic), one RA colpopexy, one open pelvic cervical cerclage with mesh and one RA removal of an invasive endometrioma. In all, 49 genitourinary (GU) injuries were sustained: ureteric ligation (26), ureterovaginal fistula (10), ureterocutaneous fistula (one), vesicovaginal fistula (VVF; 10) and cystotomy alone (two). In all, 10 patients (23.3%) underwent immediate urological repair at the time of their OBGYN RA surgery. The mean (range) time between OBGYN injury and definitive delayed repair was 23.5 (1-297) months. Four patients had undergone prior failed repair: two open VVF repairs and two balloon ureteric dilatations with stent placement. In all, 22 ureteric re-implants (11 with ipsilateral psoas hitch) and 15 uretero-ureterostomies were performed. Stents were placed in all ureteric cases for a mean (range) of 32 (1-63) days. In all, 10 VVF repairs and two primary cystotomy closures were performed. Drains were placed in 28 cases (57.1%) for a mean (range) of 4.1 (1-26) days. No case required open conversion. Two patients (4.1%) developed ureteric obstruction after RA repair requiring dilatation and stenting. The mean (range) follow-up of the entire cohort was 16.6 (1-63) months. RA repair of GU injuries during OBGYN surgery is associated with good outcomes, appears safe and feasible, and can be used successfully immediately after injury recognition or as a salvage procedure after prior attempted repair. RA techniques may improve convalescence in a patient population where quick recovery is paramount.

English

Ureterocutaneous fistula could be Urological, Gynecological or due to malignancy and trauma. However ureterocutaneous fistula due to persistent stone in ureteral stump long time after nephrectomy is rare. We report this case and its management due to its rarity. INTRODUCTION: An ureterocutaneous fistula is defined as abnormal communication between the urinary tract and skin. It may arise from the urinary tract anywhere from kidney to the urethra. Ureterocutaneous fistula may occur as a result of chronic infection especially in the setting of calculus disease. 1

Readmission After Robot-assisted Radical Cystectomy: Outcomes and Predictors at 90-Day Follow-up

To characterize the outcomes and predictors of readmission after robot-assisted radical cystectomy (RARC) during early (30-day) and late (31-90-day) postoperative periods. We retrospectively evaluated our prospectively maintained RARC quality assurance database of 272 consecutive patients operated between 2005 and 2012. We evaluated the relationship of readmission with perioperative outcomes and examined possible predictors during the postoperative period. Overall 30- and 90-day mortality was 0.7% and 4.8%, respectively, with 25.5% patients readmitted within 90 days after RARC (61% of them were readmitted within 30 days and 39% were readmitted between 31-90 days postoperatively). Infection-related problems were the most common cause of readmission during early and late periods. Overall operative time and obesity were significantly associated with readmission (P = .034 and .033, respectively). Body mass index and female gender were independent predictors of 90-day readmission (P = .004 and .014, respectively). Having any type of complication correlated with 90-day readmission (P = .0045); meanwhile, when complications were graded on the basis of Clavien grading system, only grade 1-2 complications statistically correlated with readmission (P = .046). Four patients needed reoperation (2 patients in early "for appendicitis and adhesive small bowel obstruction" and 2 in late "for ureteroenteric stricture" readmission); meanwhile, 6 patients needed percutaneous procedures (4 patients in early "1 for anastomotic leak and 3 for pelvic collections" and 2 "for pelvic collections and ureterocutaneous fistula" in late readmission). The rate of readmission within 90 days after RARC is significant. Female gender and body mass index are independent predictors of readmission. Outcomes at 90 days provide more thorough results, essential to proper patient counseling.

55 READMISSION FOLLOWING ROBOT-ASSISTED RADICAL CYSTECTOMY: OUTCOMES & PREDICTORS AT 90-DAYS

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-Based Medicine & Outcomes (I)1 Apr 201355 READMISSION FOLLOWING ROBOT-ASSISTED RADICAL CYSTECTOMY: OUTCOMES & PREDICTORS AT 90-DAYS Ali AL-Daghmin, Rakeeba Din, Aabroo khan, Ahmed Aboumohamed, Jenna Sztorc, Diana Mehedint, Mohamad Sharif, Yi Shi, Gregory Wilding, and Khurshid A. Guru Ali AL-DaghminAli AL-Daghmin Buffalo, NY More articles by this author , Rakeeba DinRakeeba Din Buffalo, NY More articles by this author , Aabroo khanAabroo khan Buffalo, NY More articles by this author , Ahmed AboumohamedAhmed Aboumohamed Buffalo, NY More articles by this author , Jenna SztorcJenna Sztorc Buffalo, NY More articles by this author , Diana MehedintDiana Mehedint Buffalo, NY More articles by this author , Mohamad SharifMohamad Sharif Buffalo, NY More articles by this author , Yi ShiYi Shi Buffalo, NY More articles by this author , Gregory WildingGregory Wilding Buffalo, NY More articles by this author , and Khurshid A. GuruKhurshid A. Guru Buffalo, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1431AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite advances in minimally invasive approaches to radical cystectomy significant morbidity remains unchanged. We sought to characterize the outcomes and predictors of readmission after RARC during early (30-day) and late (31-90- day) postoperative period. METHODS We retrospectively evaluated our prospectively maintained robot-assisted radical cystectomy (RARC) quality assurance database of 272 consecutive patients operated between 2005 and 2012. We evaluated all peri-operative outcomes and their relationship with readmission and examined for possible predictors during early and late postoperative periods. RESULTS Overall 30 & 90-day mortality was 0.7 and 4.8% respectively. 25.5% patients were readmitted within 90 days following RARC (61%-early; ≤30-day readmission and 39% late; 30-90 day readmission). Infection-related issues were the most common causes of readmission in both early & late periods. Overall operative time and obesity were significantly associated with readmission (p-value=0.034 and 0.033, respectively); meanwhile body mass index (BMI) and female gender were independent predictors of 90-day readmission (p-value=0.004 and 0.014, respectively). Getting any type of complications statistically correlated with 90-day readmission (p-value=0.0045), meanwhile when complications were graded based on Clavien grading system, grade 1-2 statistically correlated with readmission (p-value=0.046), while higher grade complications did not. 4 patients needed reoperation (2 patients in the early “for appendicitis and adhesive small bowel obstruction” and 2 in the late “for uretero-enteric stricture” readmission), meanwhile, 6 patients needed percutaneous procedures (4 patients in the early “1 for anastomotic leak and 3 for pelvic collections”, and 2 “for pelvic collections and uretero-cutaneous fistula” in the late readmission). CONCLUSIONS Rate of readmission within 90 days after RARC is significant. Female gender and BMI were found to be independent predictors of readmission. Reporting of outcomes at 90-days helps report thorough outcomes, which benefit in proper counseling of patients undergoing radical cystectomy. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e22 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ali AL-Daghmin Buffalo, NY More articles by this author Rakeeba Din Buffalo, NY More articles by this author Aabroo khan Buffalo, NY More articles by this author Ahmed Aboumohamed Buffalo, NY More articles by this author Jenna Sztorc Buffalo, NY More articles by this author Diana Mehedint Buffalo, NY More articles by this author Mohamad Sharif Buffalo, NY More articles by this author Yi Shi Buffalo, NY More articles by this author Gregory Wilding Buffalo, NY More articles by this author Khurshid A. Guru Buffalo, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Forgotten stone in a ureteral stump increased the risk of an ureterocutaneous fistula

Here we report a female patient with diabetes who underwent right nephrectomy 18 years ago for pyonephrosis and renal stone formation. Before she was performed the right nephrectomy, a ureteral calculus impacted in the right ureteral stump was diagnosed. However, after 18 years, a right ureterocutaneous fistula was diagnosed, and the calculus was still found in the ureteral stump of the patient. As a result, a fistula caused by the ureter-impacted calculus was highly suspected. We successfully performed a right ureterectomy, fistulectomy, and debridement on the patient. From our experience in this case, we strongly recommend that a calculus impacted in the ureteral stump should be removed to prevent the occurrence of postoperative complications such as ureterocutaneous fistula.

Successful Endoscopic Management of a Chronic Transplant Ureterocutaneous Fistula

To illustrate a minimally invasive, well-tolerated, clinically, and cost-effective method for surgically managing a high-output, transplant ureterocutaneous fistula manifesting as chronic urinary tract infection and recurrent pyelonephritis. This method will subject the immunosuppressed patient to less morbidity and minimize risk to the functioning renal graft. A combined percutaneous-endoscopic fistula closure method was developed using Deflux® to cystoscopically occlude the transplant ureteral orifice and Bioglue® to seal the ureter and fistula tract. The patient was infection free, completely dry, and had no voiding dysfunction after undergoing this occlusion method. This report demonstrates that this minimally invasive technique is a safe, well-tolerated, and effective technique that may be offered as an outpatient, first-line therapy over open or laparoscopic excision.

Fístula ureterocutánea tras nefrectomía: aportación de dos casos y revisión de la literatura

The ureteral fistulas are related to the gynecological surgery, digestive surgery and reconstructive urologic surgery of the upper urinary tract. Fistulas are described ureterovaginal, ureteroduodenal, ureterocolonic, ureteropleural, ureterovascular, etc.However, the ureterocutaneous fistulas of the ureteral stump after nephrectomy are a very unusual entity. We report two cases as well as their resolution by means of surgery.

Right laparoscopic donor nephrectomy and the use of inverted kidney transplantation: an alternative technique

To report a novel approach to overcome the problems associated with a short right renal vein harvested by clipping the vein during right laparoscopic donor nephrectomy (RLDN). This prospective study included 32 donors and their recipients; all donors had transperitoneal RLDN. The right renal artery and vein were ligated by Hem-o-lok and titanium clips, which resulted in a very short renal vein (<1.5 cm). When the kidney was positioned inverted in the recipient, the renal vein was placed posteriorly, adjacent to the external iliac vein, making a safe and simple venous anastomosis possible. All RLDN were completed with no conversion or re-operation. The mean (range) warm ischaemia time was 9.59 (3-17) min and there was no malfunction of the vascular clips on the major vessels. After a mean follow-up of 14 months the recipient survival rate was 97%. Graft function was excellent, with a mean (sd) serum creatinine level of 1.35 (0.31) mg/dL at 3 months after surgery, and there was no renal artery or vein thrombosis in any of the grafts. There were two ureteric complications (6%), i.e. one ureterocutaneous fistula resolved by secondary ureteroureterostomy, and one stricture at the site of ureteric anastomosis, which was managed by ureteroneocystostomy. The right renal vein obtained by LDN, after clipping the renal vein, is quite short, but by placing the kidney upside-down in the right iliac fossa transplantation is possible with no increased incidence of vascular thrombosis. This simple modification might obviate the need for removing a patch from the inferior vena cava, which is a challenging procedure for laparoscopic surgeons during RLDN.