Rectourethral fistula is an uncommon but devastating condition resulting from surgery,radiation,trauma,inflammation,or occasionally anorectal anomaly.Because of involving the urinary and the digestive system,surgical ...Rectourethral fistula is an uncommon but devastating condition resulting from surgery,radiation,trauma,inflammation,or occasionally anorectal anomaly.Because of involving the urinary and the digestive system,surgical repair can be challenging.More than 40 different surgical approaches were described in the literature.However,no standardized management exists due to the rarity and complexity of the problem.Spontaneous closure of fistula is rare and most cases need reconstructive procedures.Appropriate preoperative assessment is crucial for the decision of operation time and method.Gradually accumulating evidence indicates surgeons should take fistula size,tissue health and vascularity associated with radiation or infection,urethral stricture,and bladder neck sclerosis into consideration and make a proper treatment plan according to the features of various approaches.Accurate preoperative evaluation and proper approach selection would increase success rates.Multiple surgical team corporation,including colorectal,urological and plastic surgeons,would optimize the outcomes.展开更多
Objectives:Pelvic fracture urethral injuries(PFUI)result from traumatic disruption of the urethra.A significant proportion of cases are complex rendering their management challenging.We described management strategies...Objectives:Pelvic fracture urethral injuries(PFUI)result from traumatic disruption of the urethra.A significant proportion of cases are complex rendering their management challenging.We described management strategies for eight different complex PFUI scenarios.Methods:Our centre is a tertiary referral centre for complex PFUI cases.We maintain a prospective database(1995e2016),which we retrospectively analysed.All patients with PFUI managed at our institute were included.Results:Over two decades 1062 cases of PFUI were managed at our institute(521 primary and 541 redo cases).Most redo cases were referred to us from other centres.Redo cases had up to five prior attempts at urethroplasty.We managed complex cases,which included bulbar ischemia,young boys and girls with PFUI,PFUI with double block,concomitant PFUI and iatrogenic anterior urethral strictures.Bulbar ischemia merits substitution urethroplasty,most commonly,using pedicled preputial tube.PFUI in young girls is usually associated with urethrovaginal fistula.Young boys with PFUI commonly have a long gap necessitating trans-abdominal approach.Our success rate with individualised management is 85.60%in primary cases,79.13%in redo cases and 82.40%in cases of bulbar ischemia.Conclusion:The definition of complex PFUI is ever expanding.The best chance of success is at the first attempt.Anastomotic urethroplasty for PFUI should be performed in experienced hands at high volume centres.展开更多
基金supported by the National Natural Science Foundation of China(Nos.31370951 and 81470927)the National Science Foundation for Young Scholars of China(No.81300579)+1 种基金the Foundation for Young Scholars of Sichuan University(No.2014SCU04B21)the Application Foundation of Committee Organization Department of Sichuan Provincial Party(No.JH2015017).
文摘Rectourethral fistula is an uncommon but devastating condition resulting from surgery,radiation,trauma,inflammation,or occasionally anorectal anomaly.Because of involving the urinary and the digestive system,surgical repair can be challenging.More than 40 different surgical approaches were described in the literature.However,no standardized management exists due to the rarity and complexity of the problem.Spontaneous closure of fistula is rare and most cases need reconstructive procedures.Appropriate preoperative assessment is crucial for the decision of operation time and method.Gradually accumulating evidence indicates surgeons should take fistula size,tissue health and vascularity associated with radiation or infection,urethral stricture,and bladder neck sclerosis into consideration and make a proper treatment plan according to the features of various approaches.Accurate preoperative evaluation and proper approach selection would increase success rates.Multiple surgical team corporation,including colorectal,urological and plastic surgeons,would optimize the outcomes.
文摘Objectives:Pelvic fracture urethral injuries(PFUI)result from traumatic disruption of the urethra.A significant proportion of cases are complex rendering their management challenging.We described management strategies for eight different complex PFUI scenarios.Methods:Our centre is a tertiary referral centre for complex PFUI cases.We maintain a prospective database(1995e2016),which we retrospectively analysed.All patients with PFUI managed at our institute were included.Results:Over two decades 1062 cases of PFUI were managed at our institute(521 primary and 541 redo cases).Most redo cases were referred to us from other centres.Redo cases had up to five prior attempts at urethroplasty.We managed complex cases,which included bulbar ischemia,young boys and girls with PFUI,PFUI with double block,concomitant PFUI and iatrogenic anterior urethral strictures.Bulbar ischemia merits substitution urethroplasty,most commonly,using pedicled preputial tube.PFUI in young girls is usually associated with urethrovaginal fistula.Young boys with PFUI commonly have a long gap necessitating trans-abdominal approach.Our success rate with individualised management is 85.60%in primary cases,79.13%in redo cases and 82.40%in cases of bulbar ischemia.Conclusion:The definition of complex PFUI is ever expanding.The best chance of success is at the first attempt.Anastomotic urethroplasty for PFUI should be performed in experienced hands at high volume centres.
