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Liang Q, Lu C, Liu P, Yang M, Tang W, Jiang W. Correlation between congenital pelvic floor muscle development assessed by magnetic resonance imaging and postoperative defecation. Pediatr Surg Int 2024; 40:104. [PMID: 38600320 DOI: 10.1007/s00383-024-05691-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE Children with congenital anorectal malformation (CAM) experience challenges with defecation. This study aims to assess defecation in preschool-age children with CAM and to evaluate the correlation between pelvic floor muscle developed assessed by magnetic resonance imaging (MRI) and postoperative defecation. METHODS We collected clinical data and MRI results from 89 male children with CAM. The bowel function scores for children with Perineal (cutaneous) fistula, Rectourethral fistula(Prostatic or Bulbar), and Rectovesical fistula were computed. MRI scans were subjected to image analysis of the striated muscle complex (SMC). The association between pelvic floor muscle score and bowel function score was examined using the Cochran-Armitage Trend Test. RESULTS We observed that 77.4% of the SMC scores by MRI for Perineal fistula were good. The Rectourethral fistula SMC score was 40.6% for moderate and 59.4% for poor. The SMC score for Rectovesical fistula was 100% for moderate. Furthermore, 77.4% of patients with Perineal fistula had bowel function scores (BFS) ≥ 17 points. Among those with Rectourethral fistula and Rectovesical fistula, 12.5% and 0 had BFS ≥ 17 points, respectively. An analysis of muscle development and bowel function in patients with Rectovesical fistula, Rectourethral fistula, and Perineal fistula revealed a correlation between SMC development and BFS. Subgroup analysis showed that the Perineal fistula had statistical significance; however, the Rectourethral fistula and Rectovesical fistula were not statistically significant. CONCLUSION A correlation exists between pelvic floor muscle development and postoperative defecation in children with Perineal fistula.
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Affiliation(s)
- Qionghe Liang
- Radiology department, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Changgui Lu
- Department of Neonatal Surgery, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Peng Liu
- Radiology department, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Ming Yang
- Radiology department, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Weibing Tang
- Department of Neonatal Surgery, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Weiwei Jiang
- Department of Neonatal Surgery, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China.
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2
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Máslová D, Holubová Z, Poš L, Newland N, Pavlíková M, Škába R, Kynčl M. The comparison of magnetic resonance and fluoroscopic imaging options in the preoperative assessment of boys with anorectal malformations and a colostomy. Pediatr Radiol 2024; 54:68-81. [PMID: 38038736 DOI: 10.1007/s00247-023-05816-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND In recent decades, magnetic resonance imaging (MRI) has gained prominence as a standard diagnostic method for preoperative assessment in patients with anorectal malformations and a colostomy, with the potential to replace the classic fluoroscopic distal pressure colostogram (FDPC). Three MRI techniques are available: MRI-distal pressure colostogram with gadolinium (MRI-DPCG) or saline (MRI-DPCS) instillation into the colostomy and native MRI without colostomy instillation. OBJECTIVE To evaluate and compare the diagnostic accuracy of MRI (native MRI, MRI-DPCG and MRI-DPCS) in the preoperative workup of boys with an anorectal malformation and a colostomy and to compare it to FDPC. MATERIALS AND METHODS Sixty-two boys with preoperative MRI using one of the three approaches and 43 with FDPC met the inclusion criteria for this retrospective study. The presence and localization of rectal fistulas according to the Krickenbeck classification were evaluated and compared with intraoperative findings. RESULTS The accuracy of fistula detection for MRI in general (regardless of the technique), MRI-DPCS, MRI-DPCG, native MRI and FDPC was 95% (59/62, P<0.001), 100% (12/12, P=0.03), 100% (30/30, P<0.001), 85% (17/20, P=0.41) and 72% (31/43, P=0.82), respectively. The accuracy of describing fistula type in patients with a correctly detected fistula using these methods was 96% (45/47, P<0.001), 100% (9/9, P<0.001), 100% (23/23, P<0.001), 87% (13/15, P<0.001) and 67% (13/21, P=0.002), respectively. CONCLUSION MRI is a reliable method for detecting and classifying fistulas in boys with an anorectal malformation and a colostomy and can be considered the modality of first choice for preoperative workup.
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Affiliation(s)
- Darja Máslová
- Department of Radiology, Second Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Úvalu 84, 15006, Prague, Czech Republic.
| | - Zuzana Holubová
- Department of Radiology, Second Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Úvalu 84, 15006, Prague, Czech Republic
| | - Lucie Poš
- Department of Paediatric Surgery, Second Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Natália Newland
- Department of Paediatric Surgery, Second Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Markéta Pavlíková
- Department of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University in Prague, Prague, Czech Republic
| | - Richard Škába
- Department of Paediatric Surgery, Second Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Martin Kynčl
- Department of Radiology, Second Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Úvalu 84, 15006, Prague, Czech Republic
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Benben A, Farley R, Sanchez R, Abdelhady M. Mature rectovesical fistula after salvage cryotherapy; A rare complication following treatment for locally advanced prostate cancer. Urol Case Rep 2023; 51:102585. [PMID: 37954550 PMCID: PMC10632102 DOI: 10.1016/j.eucr.2023.102585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/01/2023] [Accepted: 10/13/2023] [Indexed: 11/14/2023] Open
Abstract
A rectovesical fistula is an abnormal connection between the bladder and rectum. A rectovesical fistula is a theoretical, but rarely documented phenomenon following locally advanced prostate cancer treatment (radiation therapy, cryotherapy, etc.). Here, we present a case report of a mature rectovesical fistula thirteen years after the patient was treated with radiation therapy and salvage cryotherapy for locally advanced prostate cancer and the various treatment options.
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4
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Reichert M, Schüler P, Stepniewski A, Felmerer G, Trojan L, von Knobloch HC. [Closure of persisting rectourethral fistula after suprasymphyseal adenoma enucleation of the prostate by combining the Bressel-Naujox and gracilis flap procedure]. Urologie 2023; 62:295-298. [PMID: 36066612 PMCID: PMC9998548 DOI: 10.1007/s00120-022-01924-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 11/29/2022]
Abstract
When taking into consideration the basic principles of fistula surgery, numerous options are available for the surgical repair of rectourethral fistulas. However, there is no standard regarding which surgical method should be used under which circumstances-due to the heterogeneity of this disease. This case report describes the individual adaptation of a surgical technique that is used for the treatment of vesicovaginal fistulas to treat a rectourethral fistula in a patient who had already undergone an unsuccessful fistula closure attempt. Successful closure of the fistula was achieved on the basis of an established method using tissue interposition.
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Affiliation(s)
- M Reichert
- Klinik für Urologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
| | - P Schüler
- Klinik für Allgemein‑, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - A Stepniewski
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - G Felmerer
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - L Trojan
- Klinik für Urologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - H C von Knobloch
- Klinik für Urologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
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5
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Gordeyev S, Ivanov V, Fedianin M, Chernikh M, Kozlov N, Petrov L, Erygin D, Gridasov I, Kaushanskiy V, Feoktistov D, Mamedli Z. Neoadjuvant chemoradiotherapy for locally advanced rectal cancer with peritumoral abscesses and fistulas. Strahlenther Onkol 2021; 198:201-208. [PMID: 34825253 DOI: 10.1007/s00066-021-01878-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/01/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Rectal cancer patients who present with peritumoral abscesses and fistulas at the time of diagnosis may be denied chemoradiotherapy (CRT) as the safety is unknown. The aim of this study was to investigate the safety of preoperative CRT in this patient group. METHODS We performed a retrospective nested case-control study to compare outcomes between patients with locally advanced rectal cancer with peritumoral abscesses and fistulas (study group) and patients with T4 locally advanced rectal cancer with no evidence of abscesses and fistulas (control group). These groups were matched by treatment center and radiotherapy delivery method. All patients received 50-54 Gy of conventionally fractionated RT with concurrent chemotherapy. Primary endpoint was grade 3-5 toxicity (by National Cancer Institute Common Toxicity Criteria for Adverse Events (NCI CTCAE). Secondary endpoints included postoperative morbidity, pathologic complete response (pCR), disease-free survival (DFS), and overall survival (OS) at 2 years. RESULTS A total of 33 patients were included in each group. Grade 3 toxicity was observed in 2 (6.1%) patients in the study group and 4 (12.1%) patients in the control group (p = 0.672). No patients developed grade 4-5 toxicity. Grade 3-4 Clavien-Dindo complications were observed in 5 (15.2%) patients in the study group and in 6 (18.2%) patients in the control group (p = 1.0). Pathologic CR was achieved in 3 (9.1%) and 5 (15.2%) patients, respectively (p = 0.708). Two-year OS was 78.3% vs. 81.8% (p = 0.944), 2‑year DFS was 62.8% vs. 69.7% (p = 0.693), respectively. CONCLUSION The presence of peritumoral abscesses and fistulas in patients with locally advanced rectal cancer is not associated with increased toxicity or inferior clinical outcomes after preoperative CRT.
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Affiliation(s)
- Sergey Gordeyev
- N.N.Blokhin National Medical Research Center of Oncology, 23, Kashirskoe shosse, 115478, Moscow, Russian Federation.
| | - Valerii Ivanov
- "PET-technology" cancer center, 26, 50 let VLKSM st., 142110, Podolsk, Russian Federation
| | - Mikhail Fedianin
- N.N.Blokhin National Medical Research Center of Oncology, 23, Kashirskoe shosse, 115478, Moscow, Russian Federation.,Department of oncology and hematology at medical faculty of the Peoples' Friendship University of Russia (RUDN University), Moscow, Russian Federation
| | - Marina Chernikh
- N.N.Blokhin National Medical Research Center of Oncology, 23, Kashirskoe shosse, 115478, Moscow, Russian Federation.,"PET-technology" cancer center, 26, 50 let VLKSM st., 142110, Podolsk, Russian Federation.,I.M.Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Nikolay Kozlov
- N.N.Blokhin National Medical Research Center of Oncology, 23, Kashirskoe shosse, 115478, Moscow, Russian Federation
| | - Leonid Petrov
- A.F. Tsyb Medical Radiological Research Center, Zhukov st., 249031, Obninsk, Russian Federation
| | - Dmitriy Erygin
- Moscow city oncological hospital № 1, Baumanskaya 17/1, 105005, Moscow, Russian Federation
| | - Ivan Gridasov
- Stavropol regional oncological dispensary, 182A, Oktyabrskaya st., 355047, Stavropol, Russian Federation
| | - Valery Kaushanskiy
- Krasnodar regional oncological dispensary, 146, Dmitrova st., 350040, Krasnodar, Russian Federation
| | - Dmitry Feoktistov
- Bashkir regional oncological dispensary, 73/1, Prospekt Octyabrya, 450054, Ufa, Russian Federation
| | - Zaman Mamedli
- N.N.Blokhin National Medical Research Center of Oncology, 23, Kashirskoe shosse, 115478, Moscow, Russian Federation
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Yoshimura K, Ohge H, Uegami S, Shimada N, Watadani Y, Nakashima I, Hirano T, Kitagawa H, Kaiki Y, Takahashi S. Ulcerative colitis-associated rectal cancer resected and diagnosed by rectovesical fistula: a case report. Clin J Gastroenterol 2021; 14:1163-8. [PMID: 34170467 DOI: 10.1007/s12328-021-01431-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 05/02/2021] [Indexed: 10/21/2022]
Abstract
Ulcerative colitis (UC), which mainly consists of mucosal lesions, rarely form colovesical or rectovesical fistulas, although few cases of fistula formation associated with comorbidities have been reported. We report a case of UC-associated rectal cancer diagnosed following symptoms associated with rectovesical fistula. A 40-year-old man with a 31-year history of extensive UC presented with difficulty in defecation. Two years before the current presentation, he had experienced pneumaturia, and the examination then had revealed a rectal neoplastic lesion and rectovesical fistula; however, tissue biopsy showed no malignancy. Therefore, he requested for observation with no further treatment. Current examination suggested the rectal tumor had grown to invade the bladder. Tissue biopsy showed no malignancy. However, the clinical symptoms and examination findings strongly indicated UC-associated rectal cancer with bladder invasion; thus, open total proctocolectomy with partial cystectomy was performed. Histopathological evaluation of the rectal neoplastic lesion revealed UC-associated rectal cancer originating from the inflammatory mucosa, and the rectovesical fistula was found to be caused by the rectal cancer invading the bladder. Therefore, other colorectal cancers should be considered even though tissue biopsy does not reveal malignant lesions in UC patients with fistula.
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7
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Peng C, Tan SS, Pang W, Wang Z, Wu D, Wang K, Chen Y. Rectourethral and rectovesical fistula as serious and rare complications after Hirschsprung disease operation: Experience in seven patients. J Pediatr Surg 2021; 56:263-268. [PMID: 32732163 DOI: 10.1016/j.jpedsurg.2020.06.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/21/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022]
Abstract
AIM To present the features and treatment of rectourethral fistula (RUF) and rectovesical fistula (RVF) after Hirschsprung disease (HD) operation. METHODS A retrospective analysis was performed on patients with RUF and RVF after HD operation, who received repair surgery from a single surgeon between January 2005 and December 2019. Bowel function was assessed using the Rintala score. RESULTS Seven patients were included. Six patients were referred to us after transanal endorectal pull-through (TEPT) in other centers; one RVF patient had fecal diversion at admission. Bladder-neck injury was detected during redo TEPT in our hospital in the remaining one patient and instant repair was given. 11 days later, RVF and sepsis were detected. Fecal and urine diversion was performed immediately. The fistula openings were prostatic urethra (3), membranous urethra (2), bladder triangle (1), and bladder-neck (1). Anastomotic stricture (4), bladder stone (3), hydronephrosis and ureterovesical junction obstruction (2), pelvic infection (2), distal colonic dilatation (1) and other fistulas (1) were identified before repair surgery. Fecal and urine diversion was performed before repair surgery in one RUF and one RVF patient respectively, to treat pelvic infection owing to fecal or urine leaks and accompanying problems. Five RUFs were repaired by transperineal approach, and two RVFs were repaired using the transabdominal and transanal approach respectively. Four patients with anastomotic stricture underwent redo TEPT with simultaneous fistula repair. Aside from one RUF patient, the fistula in all patients successfully resolved. Median follow up time was 81 months (range, 5-116 months). No recurrence was observed. Median bowel function score was 17.5 (range, 17-18). CONCLUSION The location of fistula, presence of anastomotic stricture and the association of urinary complications have significant impacts on the treatment strategy in such rare complications after TEPT for HD. THE TYPE OF STUDY Treatment study. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Chunhui Peng
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Sarah Siyin Tan
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Wenbo Pang
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Zengmeng Wang
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Dongyang Wu
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Kai Wang
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Yajun Chen
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
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8
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Kanehira E, Tanida T, Kanehira AK, Takahashi K, Obana Y, Iwasaki M, Sagawa K. A New Technique to Repair Vesicorectal Fistula: Overlapping Rectal Muscle Plasty by Transanal Endoscopic Surgery. Urol Int 2021; 105:309-315. [PMID: 33429395 DOI: 10.1159/000512379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/15/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate clinical results of a novel surgical technique, we developed to repair vesicorectal fistula (VRF) occurring after prostatectomy, hospital records of the patients, who underwent the new surgical treatment, were assessed. METHODS The novel surgical technique is called "overlapping rectal muscle plasty," which is performed under transanal endoscopic microsurgery (TEM). During the new procedure, a complete fistulectomy was first performed, and then the proper muscle layer of the rectum was folded, overlapped, and sutured to create a thick wall between the rectum and urinary bladder. This operation was carried out in 15 patients with VRF following radical prostatectomy. RESULTS The operation was safely performed in all patients with an average time of 127.2 min. Fistula was corrected in 13 patients (86.7%), who were then freed from both urinary and intestinal diversions. CONCLUSIONS Overlapping rectal muscle plasty by TEM is a safe procedure. The success rate seems to be acceptable in selected patients. This new repair method may be considered as a minimally invasive option in the surgical treatment of VRF after prostatectomy.
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Affiliation(s)
- Eiji Kanehira
- Department of Surgery, Medical Topia Soka, Soka City, Japan,
| | - Takashi Tanida
- Department of Surgery, Medical Topia Soka, Soka City, Japan
| | | | | | - Yuichi Obana
- Department of Surgery, Medical Topia Soka, Soka City, Japan
| | | | - Koji Sagawa
- Department of Urology, Medical Topia Soka, Soka City, Japan
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9
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Yan S, Sun H, Li Z, Liu S, Han B. Conservative treatment of rectovesical fistula after leakage following laparoscopic radical resection of rectal cancer. J Int Med Res 2021; 48:300060520914835. [PMID: 32250201 PMCID: PMC7137136 DOI: 10.1177/0300060520914835] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Rectovesical fistula (RVF) is a multifactorial complication that can be caused by different types of laparoscopic surgery, malignant tumor invasion, and chronic inflammation. However, RVF as a postoperative complication of laparoscopic radical rectal cancer is rare and serious. Here, we describe the case of a patient with RVF secondary to pelvic infection that was induced by anastomotic leakage. The patient was managed with conservative treatment, which included double-cavity cannula irrigation-drainage, indwelling balloon urethral catheter, treating the urinary tract infection, partial parenteral nutrition, and enteral nutrition. The patient was discharged after his symptoms had improved. In this case report, we provide a feasible scheme for patients with RVF that is induced by postoperative anastomotic fistula. Inflammatory, infectious, and thrombotic factors are presumable factors that are involved in RVF pathogenesis. These findings provide new directions for the study of RVF induced by anastomotic leakage after rectal cancer surgery. Conservative treatment may be an option in patients who want to avoid an ostomy.
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Affiliation(s)
- Shunli Yan
- Department of Gastrointestinal Surgery, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan, China
| | - Huimin Sun
- Operation Department, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan, China
| | - Zhaohui Li
- Department of Gastrointestinal Surgery, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan, China
| | - Shuaifeng Liu
- Department of Gastrointestinal Surgery, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan, China
| | - Baowei Han
- Department of Gastrointestinal Surgery, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan, China
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Grüter AAJ, Van Oostendorp SE, Smits LJH, Kusters M, Özer M, Nieuwenhuijzen JA, Tuynman JB. Minimally invasive perineal redo surgery for rectovesical and rectovaginal fistulae: A case series. Int J Surg Case Rep 2020; 77:733-738. [PMID: 33395885 PMCID: PMC7724097 DOI: 10.1016/j.ijscr.2020.11.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Iatrogenic recto-urogenital fistulae are refractory complications that rarely heal without surgical intervention. The ongoing local infection causes pain, discomfort and substantially impacts quality of life. Surgical repair requires adequate exposure and space to fill with healthy tissue, which is a major challenge in pelvic redo surgery. An abdominal approach to repair the fistula is associated with major morbidity and often fails to expose the deep pelvis. In our experience a novel transperineal minimally invasive approach a utilizing single incision laparoscopic surgery (SILS) technique could offer improved results. PRESENTATION OF CASES In the present study, three cases of patients with recto-urogenital fistulae after pelvic surgery are described. Two patients were diagnosed with a rectovesical fistula and one patient with a rectovaginal fistula. In all three cases, a minimally invasive perineal approach, using a SILS port, was used to perform surgical repair. The closure of the fistulae involved: a separate repair of the urethra/bladder or vaginal defect and the rectal defect, followed by interposition of vascularized tissue by either a pudendal thigh fasciocutaneous flap or omentoplasty. DISCUSSION AND CONCLUSION This study is the first to report on a minimally invasive perineal approach, utilizing a SILS technique for recto-urogenital fistulae repair after previous pelvic surgery. The current approach improves exposure, creates surgical space, optimizes view and allows the interposition of vascularized tissue, without causing substantial blood loss and avoiding major abdominal surgery.
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Affiliation(s)
- A A J Grüter
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, Netherlands
| | - S E Van Oostendorp
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, Netherlands
| | - L J H Smits
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, Netherlands
| | - M Kusters
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, Netherlands
| | - M Özer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Plastic Surgery, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, Netherlands
| | - J A Nieuwenhuijzen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Urology, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, Netherlands
| | - J B Tuynman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, Netherlands.
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11
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Yurtçu M. A rare presentation: Penile agenesis, vesicoureteral reflux, and rectovesical fistula in a newborn. Urol Case Rep 2019; 25:100895. [PMID: 31049291 PMCID: PMC6484947 DOI: 10.1016/j.eucr.2019.100895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/09/2019] [Accepted: 04/18/2019] [Indexed: 11/29/2022] Open
Abstract
The penis is an important organ in fertility, urinary and psychosexual structure of males. Complete penile agenesis is a rare congenital genitourinary anomaly and is usually associated with other malformations such as gastrointestinal, cardiac, and musculoskeletal lesions. Although many uncommon types have been reported, penile agenesis associated with vesicoureteral reflux has not been reported in an infant with vesicorectal fistula. This is the first report of an infant with the combination of penile agenesis, vesicoureteral reflux, and vesicorectal fistula. A three-year-old infant with penile agenesis proven to have bilateral vesicoureteral reflux and vesicorectal fistula is reported.
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Affiliation(s)
- Müslim Yurtçu
- Department of Pediatric Surgery, Meram Medical School of Necmettin Erbakan University, Konya, Turkey
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12
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van der Steeg HJJ, Botden SMBI, Sloots CEJ, van der Steeg AFW, Broens PMA, van Heurn LWE, Travassos DV, van Rooij IALM, de Blaauw I. Outcome in anorectal malformation type rectovesical fistula: a nationwide cohort study in The Netherlands. J Pediatr Surg 2016; 51:1229-33. [PMID: 26921937 DOI: 10.1016/j.jpedsurg.2016.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 02/02/2016] [Accepted: 02/02/2016] [Indexed: 01/01/2023]
Abstract
PURPOSE Outcomes of patients with an ARM-type rectovesical fistula are scarcely reported in medical literature. This study evaluates associated congenital anomalies and long-term colorectal and urological outcome in this group of ARM-patients. METHODS A retrospective Dutch cohort study on patients treated between 1983 and 2014 was performed. Associated congenital anomalies were documented, and colorectal and urological outcome recorded at five and ten years of follow-up. RESULTS Eighteen patients were included, with a mean follow-up of 10.8years. Associated congenital anomalies were observed in 89% of the patients, 61% considered a VACTERL-association. Total sacral agenesis was present in 17% of our patients. At five and ten years follow-up voluntary bowel movements were described in 80% and 50%, constipation in 80% and 87%, and soiling in 42% and 63% of the patients, respectively. Bowel management was needed in 90% and one patient had a definitive colostomy. PSARP was the surgical reconstructive procedure in 83%. Urological outcome showed 14 patients (81%) to be continent. No kidney transplantations were needed. CONCLUSION In our national cohort of ARM-patients type rectovesical fistula that included a significant proportion of patients with major sacral anomalies, the vast majority remained reliant on bowel management to be clean after ten years follow-up, despite "modern" PSARP-repair. Continence for urine is achieved in the majority of patients, and end-stage kidney failure is rare.
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Affiliation(s)
- H J J van der Steeg
- Department of Surgery-Pediatric Surgery, Radboudumc-Amalia Children's Hospital, Nijmegen, The Netherlands.
| | - S M B I Botden
- Department of Surgery-Pediatric Surgery, Radboudumc-Amalia Children's Hospital, Nijmegen, The Netherlands
| | - C E J Sloots
- Department of Pediatric Surgery, Erasmus-MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - A F W van der Steeg
- Department of Pediatric Surgery, Emma Children's Hospital, AMC and VU University Medical Center, Amsterdam, The Netherlands
| | - P M A Broens
- Department of Pediatric Surgery, University Medical Center, Groningen, The Netherlands
| | - L W E van Heurn
- Department of Pediatric Surgery, Emma Children's Hospital, AMC and VU University Medical Center, Amsterdam, The Netherlands; Department of Pediatric Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - D V Travassos
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - I A L M van Rooij
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - I de Blaauw
- Department of Surgery-Pediatric Surgery, Radboudumc-Amalia Children's Hospital, Nijmegen, The Netherlands
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