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Chacon E, Gómez-Hidalgo NR, Lago V, Boria F, Minguez JA, Chiva L. Principles of urinary reconstruction in gynecologic oncology. Int J Gynecol Cancer 2023; 33:638-639. [PMID: 37011922 DOI: 10.1136/ijgc-2023-004407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Affiliation(s)
- Enrique Chacon
- Department of Gynaecologic Oncology, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Victor Lago
- Department of Gynaecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Felix Boria
- Department of Gynaecologic Oncology, Clínica Universidad de Navarra, Madrid, Spain
| | - Jose Angel Minguez
- Department of Gynaecologic Oncology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Luis Chiva
- Department of Gynaecologic Oncology, Clínica Universidad de Navarra, Madrid, Spain
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Liang C, Liu P, Kang S, Li W, Chen B, Ji M, Chen C. Risk factors for and delayed recognition of genito urinary fistula following radical hysterectomy for cervical cancer: a population-based analysis. J Gynecol Oncol 2023; 34:e20. [PMID: 36603848 PMCID: PMC9995873 DOI: 10.3802/jgo.2023.34.e20] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 10/25/2022] [Accepted: 12/05/2022] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE This study aimed to identify the risk factors for genitourinary fistulas and delayed fistula recognition after radical hysterectomy for cervical cancer. METHODS This study was a retrospective analysis of data collected in the Major Surgical complications of Cervical Cancer in China (MSCCCC) database from 2004-2016. Data on sociodemographic characteristics, clinical characteristics, and hospital characteristics were extracted. Differences in the odds of genitourinary fistula development were investigated with multivariate logistic regression analyses, and differences in the time to recognition of genitourinary fistula were assessed by Kruskal-Wallis test. RESULTS In this study, 23,404 patients met the inclusion criteria. Surgery in a cancer center, a women's and children's hospital, a facility in a first-tier city, or southwest region, stage IIA, type C1 hysterectomy, laparoscopic surgery and ureteral injury were associated with a higher risk of ureterovaginal fistula (UVF) (p<0.050). Surgery in southwest region, bladder injury and laparoscopic surgery were associated with greater odds of vesicovaginal fistula (VVF) (p<0.050). Surgery at cancer centers and high-volume hospitals was associated with an increase in the median time to UVF recognition (p=0.016; p=0.005). International Federation of Gynecology and Obstetrics (FIGO) stage IIA1-IIB was associated with delayed recognition of VVF (p=0.040). CONCLUSION Intraoperative urinary tract injury and surgical approach were associated with differences in the development of UVFs and VVFs. Patients who underwent surgery in cancer centers and high-volume hospitals were more likely to experience delayed recognition of UVF. Patients with FIGO stage IIA1-IIB disease were more likely to experience delayed recognition of VVF.
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Affiliation(s)
- Cong Liang
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ping Liu
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shan Kang
- Department of Obstetrics and Gynecology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Weili Li
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Biliang Chen
- Department of Obstetrics and Gynecology, Xijing Hospital, Air Force Military Medical University, Xi'an, China
| | - Mei Ji
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chunlin Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Guijarro-Campillo AR, Kumar V, Patil J, Janna R, Domingo S. Modified Martius technique for complex vesicovaginal fistula repair. Int J Gynecol Cancer 2023:ijgc-2022-004131. [PMID: 36650012 DOI: 10.1136/ijgc-2022-004131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | - Veerendra Kumar
- Department of Obstetrics and Gynecology, Kalyandurg Hospital, Kalyandurg, Andra Pradesh, India
| | - Jayaprakash Patil
- Department of Obstetrics and Gynecology, Kalyandurg Hospital, Kalyandurg, Andra Pradesh, India
| | - Rakesh Janna
- Department of Urology, Bellary Medical College, Bellary, Karnataka, India
| | - Santiago Domingo
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
- Department of Gynaecology, La Fe University and Polytechnic Hospital, Valencia, Spain
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Elvas AR, Pereira BJ, Carrega F, Vicente L. [Fulminant Emphysematous Pyelonephritis Secondary to Urothelial Neoplasia with Reno-Colic Fistula]. ACTA MEDICA PORT 2018; 31:129-132. [PMID: 29596773 DOI: 10.20344/amp.8869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 08/18/2017] [Indexed: 11/20/2022]
Abstract
The emphysematous pyelonephritis is a uncommon and potentially fatal entity. The recognition of this condition enables the early correct management of patients. Diabetes and ureteral obstruction are the main risk factors identified. We present the case of a patient with no relevant risk factors or prior medical history, in which the reason of admission to the emergency department was back pain, eventually evolving into septic shock in the early hours. The imaging tests identified the presence of peri-renal and subcutaneous gas which guided the medical team to the right diagnosis (emphysematous pyelonephritis secondary to fistulized urothelial neoplasia) and the optimal surgical treatment. However, in the post-operative period the patient died, as the clinical condition and laboratory test results performed during the admission were predicting. It should also be mentioned that this same case illustrated a bacteraemia by Sphingomonas Paucimobilis (acquired in the community) with cavitated damage to lungs (probable septic embolism).
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Affiliation(s)
- Ana Rita Elvas
- Serviço de Medicina. Centro Hospitalar Cova da Beira. Covilhã. Portugal
| | | | - Filipa Carrega
- Serviço de Medicina. Centro Hospitalar Cova da Beira. Covilhã. Portugal
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Park HJ, Shin JH, Kim JW, Hong BS. Postoperative Ureteral Leak Treated Using a Silicone-Covered Nitinol Stent. Int Neurourol J 2015; 19:47-50. [PMID: 25833481 PMCID: PMC4386481 DOI: 10.5213/inj.2015.19.1.47] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 03/03/2015] [Indexed: 11/12/2022] Open
Abstract
Ureteral fistula is a serious complication of abdomino-pelvic surgeries, often resulting in poor outcomes owing to lack of proper treatment. We report the case of a 49-year-old woman who underwent placement of a silicone-covered ureteral occlusion stent in her right ureter for the management of ureteral leakage after pelvic surgery. A ureterogram obtained 18 months following the stent placement confirmed that there was no stent migration or additional urine leakage. We propose that the silicone-covered ureteral occlusion stent is practical, fast, and safe for the management of ureteral leakage.
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Abstract
Introduction: While the development of fistulae is a well-known complication of radiotherapy, such fistulae can often be challenging to manage. Case Presentation: We describe the case of a 37 year old male who developed in succession a urethrocutaneous fistula to the thigh, a rectourethral fistula and a peritoneo-urethral fistula 35 years after radiotherapy for pediatric pelvic rhabdomyosarcoma. These complications were managed successfully after multiple surgical procedures. Discussion: We subsequently discuss the different approaches currently employed for the management of radiation induced urinary fistulas and describe the rationale behind our approach towards their surgical management.
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Affiliation(s)
- Arindam Sharma
- Government Medical College and Hospital, Chandigarh, India
- Corresponding author: Arindam Sharma, Government Medical College and Hospital, Chandigarh-160030 India. Tel: +91-9888539221, Fax: +91-01772807627, E-mail:
| | - Michael P. Kurtz
- Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Jairam R. Eswara
- Massachusetts General Hospital, Harvard Medical School, Boston, USA
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Lee KN, Hwang IH, Shin MJ, Lee SB, Kim IY, Lee DW, Rhee H, Yang BY, Seong EY, Kwak IS. Pyeloduodenal fistula successfully treated by endoscopic ligation without surgical nephrectomy: case report. J Korean Med Sci 2014; 29:141-4. [PMID: 24431919 PMCID: PMC3890466 DOI: 10.3346/jkms.2014.29.1.141] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 07/08/2013] [Indexed: 11/29/2022] Open
Abstract
A 74-yr-old woman presented with fever and abdominal discomfort. She was in a septic condition caused by urinary tract infection. Her computed tomogram of the abdomen revealed features of hydronephrosis with ureteral stones in both kidneys. During percutaneous nephrostomies, right pyeloduodenal fistula (PDF) was diagnosed. Elective surgery was originally planned but the patient was in a poor condition to undergo surgery. Instead, 2 times endoscopic clipping and ligation by endoloop were applied with parenteral antibiotics for the fistula lesion. On admission day 30, she was discharged from the hospital after confirmation of no more contrast leakage on fistulography. We reviewed the literature and discuss the etiologies, clinical presentations, diagnosis, and treatment of PDF.
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Affiliation(s)
- Kyung Nam Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - In Hye Hwang
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Min Ji Shin
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea
- Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Soo Bong Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Il Young Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dong Won Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Harin Rhee
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea
- Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Byeong Yun Yang
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea
- Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Eun Young Seong
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea
- Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Ihm Soo Kwak
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea
- Medical Research Institute, Pusan National University Hospital, Busan, Korea
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Abstract
Late complications of ureteral stents are frequent, and longer indwelling times are associated with an increased frequency of complications. Although there are reports of various complications of long-term indwelling ureteral stents, a renocolic fistula secondary to a perinephric abscess resulting from an indwelling ureteral stent has not been reported. Here, we present a fatal case of a renocolic fistula secondary to a perinephric abscess caused by an encrusted forgotten double J stent in a functionally solitary kidney.
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Affiliation(s)
- Sang Wook Lee
- Department of Urology, Kangwon National University College of Medicine and Clinical Research Institute of Kangwon National University Hospital, Chunchon, Korea.
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