Anomalies of the urethra are uncommon. Urethrorectal fistula in horses has only been reported in foals and only in conjunction with other congenital anomalies. This report describes the diagnosis, surgical management, and possible etiologies of a unique case of urethrorectal fistula in a mature gelding. (+info)
Gonococcal urethral stricture and watering-can perineum.
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A total of sixteen patients with urethral stricture and/or perineal urinary fistulae (water-can perineum) complicating gonorrhoea were seen at the Special Treatment Clinic, University College Hospital, Ibadan, Nigeria. The patients were aged between 25 and 80 years, and the latent period between the time of original attack of gonococcal infection and the development of complications varied from 4 to 50 years. The rate of divorce or marital separation is high among these patients with late sequelae of gonorrhoea. The factors responsible for the present higher incidence of early and late complications of gonorrhoea among patients in Nigeria and other tropical countries compared with their counterparts in Europe and North American include: (a) Lack of medical facilities in most rural areas; (b) Inadequate treatment of veneral diseases, including the urban areas where self-medication is practised on a large scale by the general population; (c) Illiteracy and ignorance of venereal diseases. The cases of watering-can perineum reported here, and the subsequent chronic pyelonephritis and hypertension, reinforce the plea for early and energetic treatment of acute gonorrhoea in Africa as well as large-scale control measures by the health authorities. (+info)
Our surgical approach towards the treatment of urethrocele and urethral fistula.
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A new technique, described in the text, has been elaborated inspired by that of Monseur (1968) for urethral techniques. It has been performed with success in three paraplegics and in one incomplete tetraparesis. The plastic reconstruction of the diseased part of the urethra after excision of the stenosis and a fistula or diverticula by rotation and fixation to the subcavernal groove creates, in fact, an enlarged neo-urethra rendering the recurrence of the primary lesion practically impossible. This technique, first applied to spinal cord injuries, has been extended with permanent success to other lesions, such as tuberculosis stenosis and malformations. (+info)
Endovascular management of ureteroarterial fistula.
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Ureteroarterial fistulas, although rare, appear to be increasing in frequency. Because open surgical repair may be difficult and associated with significant risk for complications, endovascular intervention may provide an attractive treatment alternative. We review the diagnosis and management of a ureteroarterial fistula and iliac pseudoaneurysm that presented with massive hematuria during ureteral stent removal. The patient was treated by means of the percutaneous embolization of the right hypogastric artery and placement of an expanded polytetrafluoroethylene stent-graft. Endovascular stent-graft placement may serve as a safe and practical alternative in the treatment of these patients, whose cases are challenging. (+info)
Martius' labial fat pad interposition and its modification in complex lower urinary fistulae.
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OBJECTIVE: To assess the results of Martius' labial fat pad interposition and its modification using skin island in the repair of giant and recurrent vesicovaginal and urethrovaginal fistulae. PATIENTS AND METHODS: Fifteen patients of urethrovaginal and vesicovaginal fistulae underwent Martius' labial fat pad interposition and its skin island modification during 1996 to 1999. Ten of these were recurrent (66%) and five were giant fistulae (34%) i.e. more than five cms. RESULTS: Results were very gratifying with a successful repair in 14 patients (93%). Two patients had transient, low-grade stress incontinence, which did not need any additional procedure. In one patient, there was failure of repair, which was later successfully repaired using fat pad from opposite labia. CONCLUSION: Martius' fat pad interposition provides vascularity and surface for epithelialisation and also prevents overlapping of vesical/urethral and vaginal suture lines. Martius' repair has good results with low morbidity in the treatment of giant and recurrent urethrovaginal and vesicovaginal fistulae. (+info)
Scintiphotography in diagnosis of urinary fistula after renal transplantation.
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Scintiphotographic studies in six patients with ureteral fistula following renal transplantation are presented. Images were obtained using 99m-Tc-Sn-DTPA or 131-I-orthoiodohippurate. Urinary leakage was accurately detected in each case but the pattern of extravasation is highly variable. When carefully performed, radionuclide scintiphotography is a safe and effective method for detecting urinary leakage after renal transplantation. (+info)
Wound infections in renal transplant wounds: pathogenetic and prognostic factors.
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The factors contributing to transplant wound infection, as well as those determining its outcome, have been reviewed in 27 transplant patients with wound infection. Unrelated cadaver kidneys, diabetes, urinary fistulas and wound hematomas are all factors predisposing to wound infection. Overall incidence of wound infection in this series was 6.1% (27/439). When infections secondary to known preventable causes (i.e. hematomas and fistulas) were excluded, the incidence of wound infection was only 1.6%. Furthermore, if diabetics and retransplanted patients were excluded, the incidence of wound infection in non-diabetic patients who had their first transplant was only 0.7%. Perinephric infections are much more serious and carry a worse prognosis than superficial infections. Overall mortality of wound infections was 40% (8/27), most deaths being caused by sepsis from deep infection. Only three patients (11%) healed their wounds and saved their kidneys, whereas the rest of the survivors (15/18) healed their wounds but lost their kidneys. It is emphasized that prevention of hematomas and urinary fistulas is the most important measure in the prevention of transplant wound infection. (+info)
OBJECTIVE: To review published reports on arterio-ureteral fistula. METHOD: Literature search. RESULTS: Eighty cases were identified. Primary fistulas were mainly seen in combination with aortoiliac aneurysmal disease. Secondary fistulas were seen after pelvic cancer surgery, often with radiation, fibrosis and ureteral stenting or after vascular surgery with synthetic grafting. The dominating symptom is massive haematuria, often with circulatory impairment. The clue to a rapid and correct diagnosis is a high degree of suspicion. Most frequently diagnosis has been obtained through angiography or pyelography. When there is a ureteral stent manipulation it will often provoke bleeding and lead to diagnosis. The fistula must be excluded and a vascular reconstruction made. Most frequently this has been obtained through occlusion of the fistula and an extra-anatomic reconstruction (femoro-femoral crossover). Recently stent-grafting has been successfully used but follow-up is short. CONCLUSION: Arterio-ureteral fistula is rare and should be suspected in patients with complicated pelvic surgery and massive haematuria, especially where rigid ureteral stents have been placed. (+info)