Complex Lower Genitourinary Fistula Repair

Campbell, Jeffrey W.; Vanni, Alex J.

doi:10.1016/j.ucl.2022.04.012

Cited by 3 publications

(3 citation statements)

References 34 publications

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“…In patients with incontinence after lower urinary tract fistula repair or posterior urethroplasty, the surgeon has be to aware that gracilis interposition flaps may have been used (103,104). In our experience, gracilis flaps have not interfered with placement of a bulbar AUS cuff, as the flap is located proximal and away from the standard AUS cuff location.…”

Section: Cuff Size and Transcorporal Placementmentioning

confidence: 84%

Management of male stress urinary incontinence in high-risk patients: a narrative review

Lin¹,

Skokan²,

Wessells³

et al. 2023

Transl Androl Urol

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Background and Objectives: The artificial urinary sphincter (AUS) remains the gold standard for treatment of stress urinary incontinence (SUI). However, highly complex patients such as those with bulbar urethral compromise, bladder pathology, and lower urinary complications pose a particular challenge for the surgeon. In this article, we will address critical risk factors and synthesize existent data across relevant disease states to support surgeons in successful management of SUI in high-risk patients.Methods: A comprehensive review of current literature was performed utilizing the search term "artificial urinary sphincter" in conjunction with any of the following additional terms: "radiation", "urethral stricture", "posterior urethral stenosis", "vesicourethral anastomotic stenosis", "bladder neck contracture", "pelvic fracture urethral injury", "penile revascularization", "inflatable penile prosthesis", and "erosion". Guidance is provided based upon expert opinion where existing literature was sparse or nonexistent.Key Content and Findings: Several known patient risk factors are associated with AUS failure and can ultimately lead to device explantation. Each risk factor requires careful consideration and investigation, or intervention as appropriate, prior to device placement. Optimization of urethral health, confirmation of anatomic and functional stability of the lower urinary tract, and thorough patient counseling are a necessity for these high-risk patients. Several surgical strategies to decrease device complications can be considered: optimization of testosterone, avoidance of 3.5 cm AUS cuff, transcorporal AUS cuff placement, relocation of AUS cuff site, use of lower pressure-regulating balloon, penile revascularization, and intermittent nocturnal deactivation.Conclusions: A number of patient risk factors are associated with AUS failure and can ultimately lead to device explantation. We present an algorithm for management of high-risk patients. Optimization of urethral health, confirmation of anatomic and functional stability of the lower urinary tract, and thorough patient counseling are a necessity for these high-risk patients.

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Section: Cuff Size and Transcorporal Placementmentioning

confidence: 84%

Management of male stress urinary incontinence in high-risk patients: a narrative review

Lin¹,

Skokan²,

Wessells³

et al. 2023

Transl Androl Urol

View full text Add to dashboard Cite

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“…Rectourethral fistula (RUF) is an uncommon and devastating complication that can occur following prostate cancer treatment [46]. In the context of pelvic extirpative surgery, RUF is often seen as a complication of prostate cancer and anorectal cancer treatment.…”

Section: Rectourethral Fistulamentioning

confidence: 99%

“…Since irradiated fistulas are becoming more common, the need for an interposition flap for adequate blood supply and the barrier between the rectum and urethra makes this approach appealing. If there is concomitant urethral stricture or a large urethral defect, surgeons may supplement their repair with buccal mucosal grafts [46]. Transabdominal repairs have previously been described but have largely fallen out of favor.…”

Section: Rectourethral Fistulamentioning

confidence: 99%

Pelvic Extirpative Surgery for the “End-Stage Irradiated Bladder”

Moring,

Barrett,

Peterson

et al. 2023

Cancers

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Men with prostate cancer have the daunting task of selecting from multiple modalities of treatment. The long-term effects of radiation therapy are only now being recognized. For both patients and surgeons, the end-stage irradiated bladder poses numerous problems and challenges. Specifically, irradiated bladders with urosymphyseal fistula, radiation cystitis, and rectourethral fistula are challenging to manage and treat. This review outlines the presentation, workup, and management including cystectomy for these three devastating late complications of radiation therapy. There are special considerations when performing benign cystectomy that are not typically considered during oncologic cystectomy. We discuss an overview of the current literature regarding the “end-stage bladder” resulting from radiation therapy and the important considerations that must be acknowledged when managing these patients. It is shown that many of the less invasive and conservative options ultimately lead to cystectomy. Indeed, our review concludes that cystectomy with urinary diversion is a safe and viable option in select irradiated patients with the goal to improve quality of life.

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