Urogenital Fistulas and Female Urethral Diverticula

2020 ◽  
Author(s):  
Lindsey Cox ◽  
Eric S. Rovner
Keyword(s):  
Urinary Tract ◽  
Surgical Techniques ◽  
Signs And Symptoms ◽  
Urethral Diverticulum ◽  
Vascular Supply ◽  
Organ System ◽  
Fistula Tract ◽  
Urethrovaginal Fistula ◽  
Urogenital Fistula ◽  
Tract Fistula

Urogenital fistulas are a group of conditions in which the urinary tract is apparently connected to another organ system. Causes of fistula range from congenital anomalies, malignancy, trauma, infection or inflammatory conditions, ischemia, parturition, and iatrogenic sources – including surgery and radiation. Signs and symptoms of urinary tract fistula are variable and depend on the organ system involved and the size of the fistula. For patients who are appropriate surgical candidates, elective surgical repair is the mainstay of treatment of urinary tract fistula. Surgical techniques can be complex, but rely on the same key concepts: adequate exposure of the fistula tract; careful dissection and separation of the tissue layers, while minimizing cautery; multi-layer closure; watertight closure of each layer; meticulous hemostasis to prevent hematoma formation, but preserve vascular supply of tissues; use of well-vascularized tissue flaps; tension-free, non-overlapping suture lines; biopsy of tissues concerning for malignancy. This review contains 6 figures, 5 tables, and 82 references. Keywords: urogenital fistula, female bladder, vesical fistula, urinary bladder fistula, vesicovaginal fistula, urethrovaginal fistula, vaginal fistula, urethral diverticulum, urethral diverticulectomy, female urethra

Urogenital Fistulas and Female Urethral Diverticula

2020 ◽  
Author(s):  
Lindsey Cox ◽  
Eric S. Rovner
Keyword(s):  
Urinary Tract ◽  
Surgical Techniques ◽  
Signs And Symptoms ◽  
Urethral Diverticulum ◽  
Vascular Supply ◽  
Organ System ◽  
Fistula Tract ◽  
Urethrovaginal Fistula ◽  
Urogenital Fistula ◽  
Tract Fistula

Urogenital fistulas are a group of conditions in which the urinary tract is apparently connected to another organ system. Causes of fistula range from congenital anomalies, malignancy, trauma, infection or inflammatory conditions, ischemia, parturition, and iatrogenic sources – including surgery and radiation. Signs and symptoms of urinary tract fistula are variable and depend on the organ system involved and the size of the fistula. For patients who are appropriate surgical candidates, elective surgical repair is the mainstay of treatment of urinary tract fistula. Surgical techniques can be complex, but rely on the same key concepts: adequate exposure of the fistula tract; careful dissection and separation of the tissue layers, while minimizing cautery; multi-layer closure; watertight closure of each layer; meticulous hemostasis to prevent hematoma formation, but preserve vascular supply of tissues; use of well-vascularized tissue flaps; tension-free, non-overlapping suture lines; biopsy of tissues concerning for malignancy. This review contains 6 figures, 5 tables, and 82 references. Keywords: urogenital fistula, female bladder, vesical fistula, urinary bladder fistula, vesicovaginal fistula, urethrovaginal fistula, vaginal fistula, urethral diverticulum, urethral diverticulectomy, female urethra

scholarly journals A Case of Urethral Diverticulum with Surgical Repair Using Cadaveric Pericardial Tissue

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Loren Custer ◽  
Morris Jessop ◽  
Stanley Zaslau ◽  
Robert Shapiro
Keyword(s):  
Differential Diagnosis ◽  
Urinary Tract ◽  
Vaginal Discharge ◽  
Surgical Repair ◽  
Urethral Diverticulum ◽  
Surgical Correction ◽  
Definitive Treatment ◽  
Needle Localization ◽  
Vaginal Mass ◽  
Tract Infections

A urethral diverticulum is a relatively uncommon finding. The estimated prevalence is approximately 1-5% in the general population. While the definitive treatment is surgical correction, there are limited studies guiding the best approach to repair. This is the case of a 48-year-old female who initially presented with vaginal discharge, dysuria, and dyspareunia. MRI revealed the diagnosis of suspected urethral diverticulum. The patient was treated with surgical correction with the aid of needle localization prior to the procedure. After the diverticulum was excised, the resulting defect in the urethra was successfully closed with cadaveric pericardial tissue. A urethral diverticulum should be considered in the differential diagnosis when a patient presents with symptoms such as recurrent urinary tract infections (UTIs) vaginal mass, dysuria, dyspareunia, or vaginal discharge. The use of cadaveric tissue augments the surgical technique for repair.

Urinary Tract Fistula

2011 ◽  
pp. 481-495
Author(s):  
Brett D. Lebed ◽  
Eric S. Rovner
Keyword(s):  
Urinary Tract ◽  
Tract Fistula

scholarly journals Clinical, Epidemiological and Bacteriological Profile of Culture Positive Urinary Tract Infections in Febrile Children – A Cross Sectional Study

2021 ◽  
Vol 8 (10) ◽  
pp. 522-526
Author(s):  
Bhavani Shankar Rokkam ◽  
Chowdary Babu Menni ◽  
Ramu Pedada ◽  
Deepak Kumar Alikana
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Urinary Tract Infections ◽  
Urine Culture ◽  
Signs And Symptoms ◽  
Cross Sectional ◽  
Bacteriological Profile ◽  
Tract Infections ◽  
Culture Positive

BACKGROUND Urinary tract infections (UTI) constitute a common cause of morbidity in infants and children. When associated with abnormalities of urinary tract, they may lead to long-term complications including renal scarring, loss of function and hypertension. Most urinary tract infections remain undiagnosed if investigations are not routinely performed to detect them. Prompt detection and treatment of urinary tract infections and any complicating factors are important. The objective of the study is to know the clinical, epidemiological and bacteriological profile (i.e. clinical signs and symptoms, age, sex, family history, associated urinary tract abnormalities, & causative organisms) of urinary tract infections in febrile children with culture positive urinary tract infection. METHODS This descriptive, cross sectional observational study was conducted at outpatient clinics of our “child health clinics” between May 2016 and April 2017 (one year). All children aged 0 to 12 years with culture positive urinary tract infections were included in this study to evaluate the clinical, epidemiological and bacteriological profile. RESULTS A total of 69 children with culture positive urinary tract infections were included in this study. Out of 69 children included in this study, 36 (52.2 %) were females and 33 (47.8 %) were males. Overall female preponderance was seen and the M: F ratio was 0.9:1. But during first year of life in our study group we had more boys (10, 14.49 %) affected with urinary tract infection than girls. 49.3 % of urinary tract infections in the present study belonged to lower socio-economic status. Most common organism causing urinary tract infection in our group was E. coli (56.5 %). Fever (100 %), anorexia or refusal of feeds (52.2 %), dysuria (46.4 %), vomiting (46.4 %) and abdominal pain (39.1 %) were the predominant clinical manifestations observed in our study. CONCLUSIONS Urinary tract infection is a common medical problem in children and it should be considered as a potential cause of fever in children. As febrile children with urinary tract infection usually present with non-specific signs and symptoms, urine culture should be considered as a part of diagnostic evaluation. KEYWORDS Urinary Tract Infections (UTI), Febrile Children, Bacteriological Profile, Urine Culture

scholarly journals Urethrovaginal fistula repair with or without concurrent fascial sling placement: A retrospective review

2020 ◽  
Vol 15 (5) ◽  
Author(s):  
Sarah Neu ◽  
Jennifer Locke ◽  
Mitchell Goldenberg ◽  
Sender Herschorn
Keyword(s):  
Patient Characteristics ◽  
Urethral Diverticulum ◽  
Pelvic Surgery ◽  
Study Patient ◽  
Complication Rates ◽  
Urethrovaginal Fistula ◽  
Fascial Sling ◽  
Significant Difference ◽  
Sling Placement

Introduction: We sought to review outcomes of urethrovaginal fistula (UVF) repair, with or without concurrent fascial sling placement. Methods: All patients diagnosed with UVF at our center from 1988–2017 were included in this study. Patient charts were reviewed from a prospectively kept fistula database, and patient characteristics and surgical outcomes were described. Descriptive statistics were applied to compare complication rates between patients with or without fascial sling placement at the time of UVF repair. Results: A total of 41 cases of UVF were identified, all of which underwent surgical repair. Median age at diagnosis was 49 years (interquartile range [IQR] 35–62). All patients had undergone pelvic surgery. UVF etiology was secondary to stress urinary incontinence (SUI) surgery in 17 patients (41%) and urethral diverticulum repair in seven patients (17%). The most common presenting symptom was continuous incontinence in 19 patients (46%). Nineteen patients had a fascial sling placed at the time of surgery (46%), with no significant difference in complication rates (26% vs. 23%, p=0.79). Two patients had Clavien-Dindo grade I complications (5%) and one had a grade III complication (2%). Four patients had long-term complications (10%), including urinary retention, chronic pain, and urethral stricture. Two patients had UVF recurrence (5%). Median followup after surgery was 21 months (IQR 4–72). Conclusions: UVF should be suspected in patients with continuous incontinence following a surgical procedure. Most UVF surgical repairs are successful and can be done with concurrent placement of a fascial sling.

Acute cauda equina syndrome from a ruptured aneurysm in the sacral canal

1992 ◽  
Vol 77 (6) ◽  
pp. 945-948 ◽  
Author(s):  
Richard H. Schmidt ◽  
M. Sean Grady ◽  
Wendy Cohen ◽  
Sanford Wright ◽  
H. Richard Winn
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Signs And Symptoms ◽  
Vascular Supply ◽  
Ruptured Aneurysm ◽  
Collateral Flow ◽  
Content Type ◽  
Internal Iliac ◽  
The Right ◽  
Sacral Canal

✓ The case is presented of a young woman with acute cauda equina syndrome from a ruptured aneurysm in the sacral canal. The lesion was associated with pathological enlargement of the lateral sacral arteries bilaterally, which presumably occurred to provide cross-pelvic collateral flow in response to the diversion of the right internal iliac artery for renal transplantation. The patient presented with signs and symptoms of spontaneous spinal epidural hemorrhage. The radiographic features of this lesion are described. In addition to angiography and partial embolization of the vascular supply, contrast-enhanced high-resolution computerized tomography was essential in the diagnosis and treatment of this unique aneurysm.

Colo-urinary-tract fistula in the cancer patient

1979 ◽  
Vol 22 (3) ◽  
pp. 143-148 ◽  
Author(s):  
Kevin G. Looser ◽  
Stuart H. Q. Quan ◽  
Donald G. C. Clark
Keyword(s):  
Urinary Tract ◽  
Cancer Patient ◽  
Tract Fistula

Methods of Surgical Stabilization for Metastatic Disease of the Spine

Neurosurgery ◽  
1989 ◽  
Vol 25 (2) ◽  
pp. 240-252 ◽  
Author(s):  
George R. Cybulski
Keyword(s):  
Spinal Cord ◽  
Radiation Therapy ◽  
Metastatic Disease ◽  
Surgical Techniques ◽  
Signs And Symptoms ◽  
Spinal Stability ◽  
Indications For Surgery ◽  
Nerve Root Compression ◽  
Corticosteroid Administration ◽  
Selection Factors

Abstract A variety of surgical techniques is available for treatment of metastatic disease of the spine. Prior emphasis on the use of these procedures has been on their benefit as a palliative measure to relieve signs and symptoms of spinal cord and nerve root compression not aided by radiation therapy and corticosteroid administration. More recently, development of surgical techniques that combine neural decompression with restoration of spinal stability has brought about consideration of additional indications for surgery in the treatment of metastatic disease of the spine. The present scope of such surgical procedures is reviewed along with identification of the most reliable selection factors for surgical candidates in order to improve functional outcome from surgical treatment of metastatic disease of the spine. Over 70 surgical series with more than 2,000 patients treated were reviewed.

scholarly journals Giant anterior urethra stones combined with a diverticulum: a case report

2019 ◽  
Vol 101 (6) ◽  
pp. e139-e141
Author(s):  
S Chen ◽  
X Su ◽  
M Jiang ◽  
H Mi
Keyword(s):  
Case Report ◽  
Clinical Practice ◽  
Urinary Tract ◽  
Connective Tissue ◽  
Lower Urinary Tract ◽  
Urethral Diverticulum ◽  
Urinary Frequency ◽  
Anterior Urethra ◽  
Urinary Tract Symptoms ◽  
Lower Urinary

Urethral diverticulum is a condition where the urethra or the periurethral glands push into the connective tissue layers that surround it. Patients of urethral diverticulum present with nonspecific symptoms such as incontinence, urinary frequency and urgency, and pain during sexual intercourse and urination. The incidence of this condition is low. We report a case of giant anterior urethra stones combined with a diverticulum with no lower urinary tract symptoms. We believe that this case is extremely rare, and the process of diagnosis and treatment is of great significance in clinical practice.

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