Vesicocutaneous Fistula Research Articles

A Rocky Road: Bladder Stones in the Augmented Exstrophy-Epispadias Complex Patient

ObjectivesTo determine the rate of stone formation amongst patients of the exstrophy-epispadias complex with augmentation cystoplasty. We hypothesize that bowel segment choice influences the rate of stone formation after bladder augmentation and the rate of complications from bladder stone surgery. MethodsAn IRB approved institutional database of 1512 exstrophy-epispadias patients was reviewed retrospectively. Patients that had a history of bladder augmentation and were seen at our institution between 2003 and 2023 were included. ResultsOut of 259 patients, bladder stones developed in 21.6% (56), of which the bowel segment used was colon in 147 patients and ileum in 100. Stones formed in 19% of colon augments compared to 29% ileal augments, however this was not statistically significant (p=0.07). The most common primary stone component was dahllite, followed by struvite for all augments. The median time to stone treatment after augmentation was 4.14 years (0.75-31). 74% of patients had a recurrence that required a second surgery. The median time from first to second surgery and second to third surgery was 1.4 years and 2.22 years, respectively. Bladder stone surgery complications occurred in 14% of patients, vesicocutaneous fistula being the most common, and complications did not differ by augment type. Median follow up after first stone intervention was 6.07 years (0-19.5). ConclusionThe treatment of bladder stones in the exstrophy-epispadias complex remains challenging. Interventions to prevent recurrence are crucial as the majority of patients will require two or more stone surgeries in their lifetime.

Successful conservative treatment for a non-exteriorised Vesicocutaneous fistula

Cystic cutaneous fistula refers to an abnormal passageway or tunnel that forms between a cyst and the skin surface. A cyst is a closed sac or pocket containing fluid, air, or other substances, and when a connection forms between this cyst and the outer skin, it leads to the development of a fistula. The diagnosis is mainly clinical and X ray based. Primarily affects both male and female adults. Mainly caused by infection, trauma and history of recent trans cystic or cystic surgery for bladder stones, benign prostatic hyperplasia and other causes. Although treatment usually includes antibiotics, percutaneous or open surgery procedures may be needed to treat the fistula.

Extraperitoneal Laparoscopic Simple Prostatectomy for large prostatic adenomas: A single-centre experience on 14 patients with significant lower urinary tract symptoms.

There are various approaches available for surgical management of large prostatic adenomas - open, laparoscopic as well as laser enucleation - but there are no available clear cut consensus or guidelines. We present our experience in Extraperitoneal Laparoscopic Simple Prostatectomy on 14 patients with large prostatic adenoma (>100 g). This is a retrospective analysis on 14 patients with large prostatic adenoma who underwent extraperitoneal laparoscopic prostatectomy (LSP) over a period of 2 years (2021-2023). All selected patients underwent extraperitoneal LSP. The case records were retrospectively reviewed and data were collected regarding age, clinical presentation, prostate size, median surgical time, intra-operative and post-operative events, pre-operative and post-operative assessment of IPSS score, Uroflowmetry and PVR values and duration of hospital stay. A total of 14 patients underwent LSP. The median age was 64.2 years and the median prostatic size was 123.25 g. Median operative time was 150 min. None of the patients required blood transfusion; mean Post-operative day (POD) for drain removal was 2.5 days. The mean duration of hospital stay was 3.5 days. Only one patient had urinary leak and vesico-cutaneous fistula which was managed conservatively by prolonged catheterisation. At 3 months follow-up, there was significant improvement in IPSS Score (mean 7.8 vs 21.3 pre-operatively), uroflow values (mean Qmax of 27.3 vs 6.8 pre-operatively) and PVR (mean 30.5 vs 350 ml pre-operatively). Laparoscopic Simple Prostatectomy is a safe and feasible approach for large prostatic adenomas with lesser morbidity and complications and satisfactory outcome.

Mesh Migration and Vesicocutaneous Fistula Development Following Totally Extra-Peritoneal Hernia Repair

Mesh Migration and Vesicocutaneous Fistula Development Following Totally Extra-Peritoneal Hernia Repair

Giant bladder calculus in a patient with recurrent urinary tract infections

A giant bladder stone is rare and is usually defined as “giant” if its weight is over 100g. We describe a 43-year-old man who presented with urinary sepsis, hypotension, abdominal pain, and a vesicocutaneous urinary fistula. Laboratory tests showed hemoglobin 6.6 g/dL, leukocytes 22,700/mm³, creatinine 7.29mg/dL (eGFR 8.8mL/min/1.73m2), urea 181 mg/dL, serum pH 6.99 and bicarbonate 6 meq/L. Abdominal tomography showed bilaterally reduced cortical thickness of the kidneys and a bladder stone of 6x6x11 cm. He was treated with antibiotic therapy, dialysis, and open cystolithotomy. Clinical improvement was observed, despite kidney disease persistence, with chronic dialysis therapy.

Classic Bladder Exstrophy Closure Without Osteotomy or Immobilization: An Exercise in Futility?

To review the outcomes of classic bladder exstrophy (CBE) closure without the use of osteotomy or lower extremity/pelvic immobilization. A prospectively maintained institutional approved exstrophy-epispadias complex database of 1487 patients was reviewed for patients with CBE who had undergone closure without osteotomy nor immobilization. All patients were referred to the authors' institution for reconstruction later in life or for failed closure. Of a total of 1016 CBE patients, 56 closure events were identified that met inclusion with a total of 47 unique patients. Thirty-eight closures were completed prior to 1990 (67.9%). Forty-five closure events developed eventual failure (45/56, 80.4%) (Table 1). Thirteen closure events were secondary closures (13/56, 23.2%). The primary closure failure rate was 83.7% (36/43) while the secondary closure failure rate was 69.2% (9/13). Failures were attributed to one or more of dehiscence, bladder prolapse, and vesicocutaneous fistula (25/45, 55.6%) (23/45, 51.1%) (6/45, 13.3%), respectively. Thirty-seven patients developed social continence (37/47, 78.7%), while only 8 patients developed spontaneous voided continence (7/47,17.0%) (Table 2). The most common methods of voiding were continent catheterizable channels (25/47, 53.2%) of which all were socially continent. These results illustrate the critical role osteotomy and postoperative immobilization can play in both primary and secondary exstrophy closure. While this is a historical case series, the authors believe that these results remain relevant to contemporary exstrophy surgeons.

Multi-staged vs Single-staged Pelvic Osteotomy in the Modern Treatment of Cloacal Exstrophy: Bridging the Gap

PurposeStaged pelvic osteotomy has been shown in the past to be an effective tool in the closure of the extreme pubic diastasis of cloacal exstrophy. The authors sought to compare orthopedic complications between non-staged pelvic osteotomies and staged pelvic osteotomies in cloacal exstrophy. MethodsA prospectively maintained exstrophy-epispadias complex database of 1510 patients was reviewed for cloacal exstrophy bladder closure events performed with osteotomy at the authors' institution. Bladder closure failure was defined as any fascial dehiscence, bladder prolapse, or vesicocutaneous fistula within one year of closure. There was a total of 172 cloacal exstrophy and cloacal exstrophy variant patients within the database and only closures at the authors’ institution were included. Results64 closure events fitting the inclusion criteria were identified in 61 unique patients. Staged osteotomy was performed in 42 closure events and non-staged in 22 closures. Complications occurred in 46/64 closure events, with 16 grade III/IV complications. There were no associations between staged osteotomy and overall complication or grade III/IV complications (p = 0.6344 and p = 0.1286, respectively). Of the 46 total complications, 12 were orthopedic complications with 6 complications being grade III/IV. Staged osteotomy closure events experienced 10/42 orthopedic complications while non-staged osteotomy closures experienced 2/22 orthopedic complications, however this did not reach significance (p = 0.1519). Of the 64 closure events, 57 resulted in successful closure with 6 failures and one closure with planned cystectomy. ConclusionThis study confirms, in a larger series, superior outcomes when using staged pelvic osteotomy in cloacal exstrophy bladder closure. Staged osteotomy was shown to be a safe alternative to non-staged osteotomy that can decrease the risk of closure failure in this group. Staged pelvic osteotomy should be considered in all patients undergoing cloacal exstrophy bladder closure. Type of StudyTreatment study. Level of EvidenceLevel III.

Mucosal Violations and Their Effect on Successful Bladder Neck Closure in Cloacal Exstrophy

BackgroundCloacal exstrophy (CE) is rare and challenging to reconstruct. In the majority of CE patients voided continence cannot be achieved and so patients often undergo bladder neck closure (BNC). Prior mucosal violations (MVs), a surgical event when the bladder mucosa was opened or closed, significantly predicted failed BNC in classic bladder exstrophy with an increased likelihood of failure after 3 or more MVs. The aim of this study was to assess predictors for failed BNC in CE. MethodsCE patients who underwent BNC were reviewed for risk factors for failure including osteotomy use, successful primary closure, and number of MVs. Chi-squared and Fisher's exact tests were used for comparing baseline characteristics and surgical details. ResultsThirty-five patients underwent BNC. Eleven patients (31.4%) failed BNC including a vesicoperineal fistula in nine, vesicourethral and vesicocutaneous fistula in one each. The fistula rate in patients with 2 or more MVs was 47.4% (p = 0.0252). Two patients subsequently developed a vesicocutaneous fistula after undergoing repeated cystolithotomies. A rectus abdominis or gracilis muscle flap were used to close the fistula in 11 and 2 patients, respectively. ConclusionsMVs have a greater impact in CE with an increased risk of failed BNC after 2 MVs. CE patients are most likely to develop a vesicoperineal fistula while a vesicocutaneous fistula is more likely after repeat cystolithotomy. A prophylactic muscle flap should be considered at time of BNC in patients with 2 or more MVs. Levels of EvidencePrognosis Study, Level III.

An unusual presentation of penetrating bladder injury with vesicocutaneous fistula: a case report

BackgroundBlunt trauma to the urinary bladder is common with penetrating injury being a rare occasion. Most common entry pint for penetrating injuries includes buttock, abdomen and perineum with thigh being rare. There are a number of complications that may develop as a result of penetrating injury with vesicocutanous fistula being a rare occurrence that usually presents with typical sign and symptoms.Case presentationWe present a rare case of penetrating bladder injury through medial upper thigh as an entry point that had complicated into vesicocutaneous fistula with atypical presentation of long-standing pus discharge that had been managed by incision and drainage several times with no success. MRI demonstrated a presence of fistula tract and a foreign body (piece of wood) in-situ confirmed the diagnosis.ConclusionFistulas are a rare complication of bladder injuries and can cause negative impact on the quality of life of patients. Delayed urinary tract fistulations and secondary thigh abscesses are uncommon therefore a high index of suspicion is needed for early diagnosis. This case emphasizes the importance of radiological tests in aiding the diagnosis and ultimately proper management.

A rare case of vesicocutaneous fistula over the right thigh managed conservatively

Bladder trauma is encountered in 5-10% of cases of pelvic trauma [1]. The degree of the bladder injury is determined by various factors including amount of urine contained in the bladder at the time of injury, impact of the force as well as the pelvic osseous injury.

Incarcerated Inguinal Bladder Hernia: Case Report

The incidence of urinary bladder hernia accompanying inguinal hernias is 1-4%. Herniation of the urinary bladder into the inguinal canal and scrotum can cause urinary retention and hydronephrosis, bladder necrosis, and renal dysfunction. This study presents a case that underwent emergency surgery for an incarcerated inguinal hernia. The hernia sac included the urinary bladder in addition to bowel segments. An attempt to save the ischemic bladder wall during partial bowel resection failed, and the patient developed a vesicocutaneous fistula. The fistula was repaired, and the ischemic bladder wall was resected. During the repair of an inguinal hernia, general surgeons and urologists must be aware of this rare condition and work together in terms of patient management. Although the bladder-sparing approach can be performed in cases without signs of severe bladder ischemia, patients should be followed closely for complications related to ischemia.

A Rare Presentation of Vesicocutaneous Fistula as Groin Abscess after 8 Years of Laparoscopic Mesh Repair of Inguinal Hernia

Laparoscopic mesh repair of inguinal hernia is common but rarely associated with vesicocutaneous fistula as a complication. The most common implications are mesh erosion and migration due to inappropriate strategies in the selection of the mesh type, size, and placement of mesh. This case study reports a 74-year-old man who suffered immense physical, mental, and cosmetic hardship due to a vesicocutaneous fistula postlaparoscopic mesh repair of an inguinal hernia performed 8 years ago. He presented with groin abscess secondary to vesicocutaneous fistula, diagnosed with high inflammatory markers and computed tomography abdomen pelvis. Groin abscess was drained and identified vesicocutaneous fistula which was managed conservatively.

SÍNDROME DE PRUNE BELLY COM FÍSTULA VESICOCUTÂNEA: RELATO DE CASO RARO E REVISÃO DA LITERATURA

Prune Belly syndrome (PBS) is a rare complex malformation that preferentially affects male newborns. It presents with a wide spectrum of alterations that include abdominal muscle deficiency, varying degrees of renal dysplasia and urinary tract obstruction, in addition to bilateral cryptorchidism. In general, it is associated with other developmental anomalies, mainly of cardiac, pulmonary and gastrointestinal origin. Despite numerous advances in the treatment of complex malformations, morbidity and mortality in PBS remains high, due to early renal failure and associated malformations. This is a case report of a male newborn, inserted in a complex social context, born by vaginal delivery, premature, with a gestational age of 36 weeks and 1 day. At the initial assessment in the delivery room, he presented: male external genitalia, bilateral cryptorchidism, flabby and hollowed abdomen, parchment skin suggestive of the absence of abdominal muscles, mild respiratory effort and bradycardia. He received positive pressure ventilation and was referred to the Neonatal Intensive Care Unit (UTIn) where a vesicocutaneous fistula and renal failure were found, despite the vesicostomy, progressing to death at 1 month and 1 day of chronological age. Complex congenital malformations, such as PBS, require individualized assessment so that better postnatal results are achieved. However, the limitation of therapeutic care must be carefully evaluated, considering the great morbidity that accompanies these patients. This article aims to describe a rare case of PBS, detailing the evolution of patients with this malformation.

SÍNDROME DE PRUNE BELLY COM FÍSTULA VESICOCUTÂNEA: RELATO DE CASO RARO E REVISÃO DA LITERATURA

Prune Belly syndrome (PBS) is a rare complex malformation that preferentially affects male newborns. It presents with a wide spectrum of alterations that include abdominal muscle deficiency, varying degrees of renal dysplasia and urinary tract obstruction, in addition to bilateral cryptorchidism. In general, it is associated with other developmental anomalies, mainly of cardiac, pulmonary and gastrointestinal origin. Despite numerous advances in the treatment of complex malformations, morbidity and mortality in PBS remains high, due to early renal failure and associated malformations. This is a case report of a male newborn, inserted in a complex social context, born by vaginal delivery, premature, with a gestational age of 36 weeks and 1 day. At the initial assessment in the delivery room, he presented: male external genitalia, bilateral cryptorchidism, flabby and hollowed abdomen, parchment skin suggestive of the absence of abdominal muscles, mild respiratory effort and bradycardia. He received positive pressure ventilation and was referred to the Neonatal Intensive Care Unit (UTIn) where a vesicocutaneous fistula and renal failure were found, despite the vesicostomy, progressing to death at 1 month and 1 day of chronological age. Complex congenital malformations, such as PBS, require individualized assessment so that better postnatal results are achieved. However, the limitation of therapeutic care must be carefully evaluated, considering the great morbidity that accompanies these patients. This article aims to describe a rare case of PBS, detailing the evolution of patients with this malformation.

Orthopedic complications after osteotomy in patients with classic bladder exstrophy and cloacal exstrophy: a comparative study

The addition of pelvic osteotomy to the armamentarium of tools for correction of classic bladder exstrophy (CBE) and cloacal exstrophy (CE) has undeniably served as one of the most effective advancements in improving the likelihood of successful primary bladder closure. Osteotomy-related complications have been studied and documented extensively in patients with CBE, yet evaluation remains limited in CE concordant with its relative rarity. To compare orthopedic complications in patients with CBE and CE who underwent primary bladder closure with osteotomy. A prospectively maintained, IRB-approved database of 1401 exstrophy-epispadias patients was reviewed for patients with CBE or CE after primary closure and pelvic osteotomy performed at a single institution from 1975 to 2021. Failed closure was defined as dehiscence, bladder prolapse, or vesicocutaneous fistula at any point. Surgery or anesthesia-related complications were captured within 6 weeks of osteotomy or closure. A total of 146 patients were included in the analysis with 109 and 37 patients with CBE and CE, respectively. Between the CBE and CE cohorts, there were significant differences in median age at primary closure (68 days [IQR 10-260] vs 597 [448-734]; p<0.001), diastasis width (4cm IQR [3.8-4.6] vs 6.1 [5.0-7.2]; p<0.001), osteotomy at time of closure (99.1% vs 75.7%; p<0.001), and utilization of external hip fixation (67.9% vs 89.2%; p=0.011). There was no significant difference by gender, osteotomy technique, or hip immobilization technique. Regarding exstrophy closure outcomes, there were 5 failures in the CBE group and 1 in the CE group (p=1.000). Complications were experienced in 38.5% and 56.8% of CBE and CE patients (p=0.054) with a significant difference in orthopedic complications (primarily consisting of superficial pin-site infections) between the cohorts (4.6% vs 16.2%, p=0.031). There was no significant difference in grade 3 or higher complications between cohorts (5.5% vs 13.5%, p=0.147). This was the first study comparing orthopedic complications after osteotomy between CBE and CE, providing valuable insight into which factors vary among cohorts and which are associated with increased complication rates. Despite availability of high case numbers for these rare disorders, the analysis continued to be limited sample size and missing data for retrospective analysis. While exstrophy closure success and overall complications rates are similar in patients with CBE and CE, patients with CE experience more superficial pin-site infections after pelvic osteotomy. External hip fixation may be associated with the increase in orthopedic complications, though further research is required to elucidate the underlying cause of these complications.

Inflammatory Myofibroblastic Tumor in Bladder with Multiple Vesicocutaneous Fistula in Pediatric Patient: A Rare Case Report

Inflammatory myofibroblastic tumor (IMT) is a rare tumor that occurs at any age from childhood to late adulthood and may have a slight male predilection. A 7-year-old female presented with gross hematuria and a lump in the lower abdomen since 1 month prior to admission. The complaints were also accompanied by weight loss, abdominal pain and anemia. Ultrasound examination, Cystography, CT-Scan and MRI showed that mass in the bladder. Histopathology examination confirmed diagnosis for IMT, thus, radiology plays an important role in supporting histologic examination for diagnosis and evaluation of IMT.

Value of CT sinography and analysis of missed diagnosis and misdiagnosis for abdominal wall sinus

BackgroundThe value of CT (computed tomography) sinography in evaluating abdominal wall sinus tracts is currently unclear. The present study aims to investigate the accuracy of CT sinography in diagnosing the extent of abdominal sinus and analyze the reasons for misdiagnosis.Materials and methods64 patients with abdominal sinus tract formation (including fistula) undergoing CT sinography in our hospital from January 2018 to November 2020 were retrospectively analyzed. The CT images were blindly and independently re-assessed by two radiologists with 5- and 18-years work experience, respectively. Whether the sinus tract was confined to the abdominal wall or had invaded the abdominal cavity, and whether there was fistula formation were evaluated. The accuracy of CT sinography in diagnosing sinus invasion in the abdominal cavity and fistula formation was calculated. The agreements of CT sinography-surgical results and inter-observer were assessed using weighted-kappa statistics.ResultsThe weighted- Kappa of inter-observer agreement (0.825, P < 0.001) and CT sinography—surgical results (0.828, P < 0.001) were both perfect. The diagnostic accuracy, sensibility, and specificity of sinus tract confined to the abdominal wall were 90.6% (95% CI: 80.7–96.5), 85.7% (95% CI: 67.3–96.0), and 94.4% (95% CI: 81.3–99.3), respectively. The diagnostic accuracy, sensibility, and specificity of fistula formation were 93.8% (95% CI: 84.8–98.3), 89.5% (95% CI: 66.9–98.7), and 95.6% (95% CI: 84.9–99.5), respectively. A total of 4 cases of sinus tract confined to the abdominal wall were misdiagnosed as invading the abdominal cavity, 2 cases of sinus tract invading the abdominal cavity were misdiagnosed as confined to the abdominal wall, 2 cases of enterocutaneous fistula were missed, 1 case of enterocutaneous fistula was misdiagnosed, 1 case of vesico-cutaneous fistula was misdiagnosed, and no cases of vesico-cutaneous fistula were missed.ConclusionsCT sinography can accurately assess the extent of an abdominal sinus tract and reveal fistula formation, despite some inevitable misdiagnosis and missed diagnosis. Radiologists should find more clues to improve the diagnostic accuracy.

MP25-08 URINARY TRACT RECONSTRUCTION WITH ENTEROCYSTOPLASTY AFTER RADIATION FOR PELVIC CANCER

You have accessJournal of UrologyCME1 May 2022MP25-08 URINARY TRACT RECONSTRUCTION WITH ENTEROCYSTOPLASTY AFTER RADIATION FOR PELVIC CANCER Sender Herschorn, and Jenn Locke Sender HerschornSender Herschorn More articles by this author , and Jenn LockeJenn Locke More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002568.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radiation (RT) for pelvic cancer may compromise the urinary tract. Reconstruction can be challenging especially at the time of surgical removal of the tumor. As an alternative to cystectomy, enterocystoplasty (EC) +/- ureteral reimplantation or continent catheterizable channel (CCC) brings the potential benefits of preserving the LUT. We report our experience in a series of patients, all of whom had RT, to assess outcomes and complications. METHODS: This is a retrospective case series of all post-RT patients who underwent EC to reconstruct the LUT between 1994 and 2021 from one institution. Complications and functional results were recorded. RESULTS: 36 patients (18 women,18 men) who had prior RT for treatment of advanced or recurrent pelvic cancer were identified. 10 patients, post chemo-RT for colorectal cancer, underwent immediate reconstruction after tumour excision, which included part of the bladder +/- ureter(s) (group 1) and 26 after RT for prostate (7), gynecologic (13), colorectal (5) and liposarcoma (1) had surgery due to RT complications (group 2). Mean age at surgery was 58 yrs (median 58.5; range 33-76). All patients underwent EC and 24 (67%) had simultaneous ureteral reimplants either into an afferent intestinal limb (17) or into the bladder (7) with 16 undergoing bilateral reimplants. Reimplants were done for obstruction due to tumor (group 1) or post-RT (group 2). 8 patients in group 2 had simultaneous CCC due to devastated urethras. The median postop length of stay (LOS) was 9 days (4-25) and was significantly shorter in group 2 vs. group 1; 8 (IQR 6-10) vs. 13 (IQR 10-14) (p=0.0039). No early (within 30 days) surgical reintervention was prompted by the LUT reconstruction. After a median follow-up of 38.5 mo. (range 2-195), 9 patients (29%) required reinterventions including 4 open operations (1 parastomal hernia, 1 vesicovaginal, 2 vesico-cutaneous fistulae), 2 ureteral intestinal anastomotic stricture dilations, and 3 endoscopic bladder stone removals. Reintervention rate was similar in the groups. Renal function was preserved. 23/28 non-stoma patients void spontaneously, 3 perform intermittent catheterization (IC), and 2 have indwelling catheters. 7/8 stoma patients do IC and one is awaiting persistent vesicocutaneous fistula repair with an indwelling catheter. At last follow-up, 32/36 patients considered their LUT management to be successful. CONCLUSIONS: Prior pelvic RT is not a contraindication to EC with or without ureteral reimplantation and/or CCC. Longer LOS was seen in the extirpative group. Acceptable functional outcomes and morbidity can be achieved. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e430 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sender Herschorn More articles by this author Jenn Locke More articles by this author Expand All Advertisement PDF DownloadLoading ...

Urinary tract infection caused by bacterial pathogens of the respiratory tract in children.

Urinary tract infections (UTIs) caused by bacterial pathogens of the respiratory tract such as Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are rare and little is known about their clinical features and potential host risk factors. The aim of this study is to reveal their clinical characteristics. We conducted a retrospective descriptive study on pediatric UTI due to S.pneumoniae, Haemophilus spp., or M.catarrhalis at a tertiary-care pediatric hospital. Pediatric patients diagnosed with UTI between 2002 and 2020 were included. Patient demographics, laboratory data, and microbiological findings were extracted from their electronic medical records and the infectious disease surveillance system. Among 46,332 urine samples, 76 bacteriuria (0.16%) and 22 UTI (0.05%) events due to the targeted species were identified (S.pneumoniae, n=7, and Haemophilus spp., n=15). Of the patients, 17 (85%) had underlying urinary tract abnormalities and 13 (60%) had vesicocutaneous fistula. All the UTI episodes caused by S.pneumoniae and Haemophilus spp. occurred after cystostomy. All the patients had satisfactory clinical outcomes. Although S.pneumoniae and Haemophilus spp. are rare causes of UTIs in children, they could be the true causative bacteria of UTI, particularly in the patients with urinary tract abnormalities and vesicocutaneous fistulas. Thus, clinicians should not ignore these pathogens as contaminations in special populations.

V06-08 SALVAGE ENBLOC LASER ENUCLEATION OF PROSTATE AFTER PROSTATIC ARTERY EMBOLIZATION

You have accessJournal of UrologyBPH & Infection & Imaging (V06)1 Sep 2021V06-08 SALVAGE ENBLOC LASER ENUCLEATION OF PROSTATE AFTER PROSTATIC ARTERY EMBOLIZATION Nicholas Smith, Jonathan Katz, and Hemendra Shah Nicholas SmithNicholas Smith More articles by this author , Jonathan KatzJonathan Katz More articles by this author , and Hemendra ShahHemendra Shah More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002021.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Though not currently recommended as a treatment for benign prostatic hyperplasia by the American Urological Association (AUA), prostatic artery embolization (PAE) is often selected, in and out of clinical trials, as an option in men who have large prostate volumes >40 mL, surgical comorbidities, and anticoagulation dependence. Current literature suggests that 20-36% patients will fail to respond to PAE and will require surgical management for their enlarged prostate. Examination of prostate tissue after PAE show necrosis and granulomatous reaction, raising concern for any subsequent surgical intervention. Holmium laser enucleation of prostate (HoLEP) is a surgical option for BPH patients that the AUA recommends for prostates of all sizes. Patients that have failed PAE may turn to HoLEP since it is the next least invasive surgical option for massively enlarged prostates. For this reason, we present a video demonstrating our experience performing a salvage HoLEP after PAE. METHODS: An 85 year old wheelchair-bound male with a history of dementia, open cystolithalopaxy two years prior complicated by a vesico-cutaneous fistula, and chronic urinary retention and recurrent urosepsis. He underwent PAE nine months prior to presentation, however failed subsequent voiding trials, experienced recurrent urosepsis, persistent fistula drainage, and required chronic urethral catheterization that resulted in hypospadias. The patient and family desired for the patient to be catheter-free and elected HoLEP. His prostate volume was 135 cc with intra-prostatic cavities secondary to PAE. We utilized the Moses Pulse 120-Watt laser with a 550-micron laser fiber at 2 Joules and 30 Hz. The enucleated prostate was morcellated with VersaCut Morcellator. RESULTS: Despite embolization and diffuse necrosis throughout the specimen, the surgical capsule was preserved throughout. The procedure was notable for minimal bleeding due to the vascularity of the prostate after embolization. Procedure time was 90 minutes and estimated blood loss was 20 mL. Pathology demonstrated BPH, inflammation, necrosis, and embolization spherules. The patient was discharged home on first postoperative day after a successful voiding trial with a PVR of 0 mL. At two-week follow up, the patient’s family states that he voids volitionally, with minimal incontinence. CONCLUSIONS: This video demonstrates that HoLEP after PAE can be safely performed and may be an excellent salvage surgical option for such patients. Despite tissue changes induced by embolization, the surgical capsule is preserved in our experience. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e451-e451 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicholas Smith More articles by this author Jonathan Katz More articles by this author Hemendra Shah More articles by this author Expand All Advertisement Loading ...