Progression of pressure ulcer to vesico-cutaneous fistula

Nassir, Anmar; Bell, David

doi:10.1016/j.jtv.2009.02.003

Cited by 9 publications

(5 citation statements)

References 8 publications

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“…UCF during SPPU in adults with SCI is a serious condition but only small series or case reports can be found in the literature. [11][12][13][14][15] In the present study, we report the largest cohort in the literature (74 patients).…”

Section: Discussionmentioning

confidence: 74%

“…The urinary diversion was noncontinent in 85.9% (n = 61) with an ileal conduit according to the Bricker technique in 55 patients. Cystectomy was performed in 80.9% (n = 55) and the length of stay in the urology unit was 16 days (IQR, [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. The period between urinary diversion and pressure ulcer surgery was 3 months (IQR, 1.4-7.0).…”

Section: Perioperative Outcomes Of Urinary Diversion Surgerymentioning

confidence: 99%

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Management of urethrocutaneous fistulae complicating sacral and perineal pressure ulcer in neurourological patients: A national multicenter study from the French‐speaking Neuro‐urology Study Group and the Neuro‐urology committee of the French Association of Urology

Gambachidze

Lefèvre

Chartier‐Kastler

et al. 2019

Neurourology and Urodynamics

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Purpose To describe the epidemiologic characteristics of urethrocutaneous fistulae (UCF) in sacro‐perineal pressure ulcer (SPPU) in neurourological patients and to assess outcomes after surgical urinary diversion. Materials and Methods Through the French‐speaking Neurourology Study Group and Association of Urology network, a retrospective multicenter study in nine major urology and physical medicine and rehabilitation (PMR) units was conducted. All patients with SPPU associated with UCF between 2000 and 2016 were included. Data concerning: sociodemography, clinical, medical and biological comorbidities, neurological and urological history, pressure ulcer characteristics, and finally urinary diversion surgery were collected. Complications and SPPU healing/relapse were assessed. Results In all, 74 patients were included. The median age on diagnosis: 45.9 years (interquartile range [IQR], 38.7‐53.4) and median follow‐up: 15.1 months (IQR, 5.7‐48.8). A psychiatric disorder was the most frequent comorbidity (44.6%). Only 59.5% and 50% had regular PMR and urologic follow‐up, respectively. Seventy‐one patients (95.9%) underwent urinary diversion surgery. Among those, relapse occurred in 15 (21.1%) at the end of the follow‐up. The diversion was noncontinent in 85.9%. The major complications rate was 26.8%. A total of 30 late complications in 21 patients were reported. The most frequent was obstructive pyelonephritis (n = 9). All of the patients who underwent surgical diversion without cystectomy (n = 5) developed a pyocyst. Finally, the pressure ulcer healing rate when patients underwent both urinary diversion and pressure ulcer surgery was 74.4%. Conclusions Our retrospective data suggest that UCF complicating SPPU is a rare and severe pathology. The combination of radical urinary diversion with cystectomy and pressure ulcer surgery should be performed as often as possible.

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Section: Discussionmentioning

confidence: 74%

Section: Perioperative Outcomes Of Urinary Diversion Surgerymentioning

confidence: 99%

Management of urethrocutaneous fistulae complicating sacral and perineal pressure ulcer in neurourological patients: A national multicenter study from the French‐speaking Neuro‐urology Study Group and the Neuro‐urology committee of the French Association of Urology

Gambachidze

Lefèvre

Chartier‐Kastler

et al. 2019

Neurourology and Urodynamics

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“…The most employed surgical intervention is an uretroplasty with the eventual interposition of a buccal mucosal graft for long defects in conjunction to the skin ulcer repair with muscular flaps. [7][8][9][10] Secrest et al presented one of the first report about the urethral reconstruction in spinal cord injured patients. They collected 18 patients with different urethral pathologies (strictures, diverticula, erosion, and urethrocutaneous fistula).…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Management of complex ischial-urethral fistula in neurogenic patients performing clean intermittent self-catheterization

et al. 2021

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Introduction: Neurogenic patients performing clean-intermittent self-catheterization (CIC) may develop an urethral erosion, resulting in ischial-urethral fistulas (I-UF). In this work we present our single-center experience in dealing with this peculiar complication. Methods: In this work we included all neurogenic patients performing CIC treated at out Institution for I-UF. All patients had a spinal cord injury or myelomeningocele. We extracted from the patients’ medical records the surgical management and postoperative clinical data. We defined failure the persistence of the fistula at X-ray contrast fistulography, retrograde urethrography, or uretrocystoscopy. Results: We treated 11 patients (8 spinal cord injury, 3 myelomeningocele). Four patients have been treated with the placement of a new generation urethral stent (Uventa) after surgical toilette of the skin ulcer and placement of a temporary suprapubic catheter. All patients demonstrated a complete healing of the urethral lesion at stent removal and continued CIC without any difficulty. Four patients have been treated with perineal urethroplasty, requiring a buccal mucosal graft in two cases. In two patients a suprapubic permanent catheter was placed for a simpler bladder management due to the patients’ comorbidities. In one case the incidental finding of an high grade muscle invasive urothelial bladder cancer, made it mandatory to perform an uretheroileocutaneostomy. Conclusions: This work represent a unique series of I-UF in neurogenic patients performing CIC. Surgical urethral reconstruction, often with the use of buccal mucosa in large lesions, may be a difficult solution in neurogenic patients, new generation stents (Uventa) represent a minimally invasive, effective, and safe alternative.

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“…By correcting the cause the fistula may resolve without surgical intervention. 37 However the vast majority of cases require surgery at some stage. Urethral reconstruction is possible, but this is reduced to case reports with mixed outcomes most of which ultimately end in some form of urinary diversion.…”

Section: Investigation and Managementmentioning

confidence: 99%

Urethral Complications in Spinal Cord Injury

Gordon¹,

Mangera²

2018

J Reconstr Urol

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rethral complications are recognised in patients post spinal cord injury (SCI) and can be challenging to manage. Our aim was to review the literature to identify the aetiology, incidence, risk factors and management for urethral complications in spinal cord injured patients. METHODSA search was carried out using the PubMed database for peer reviewed articles on 01/01/18. The following search terms were used: "spinal cord injury", "cauda equina", "neuropathic bladder" "neurogenic bladder" and were combined with "urethral complications", "urethral stricture", "urethral di- J Reconstr Urol 2018;8(1):21-7 21Urethral Complications in Spinal Cord Injury A AB BS S T TR RA AC CT T Spinal cord injury may pose a difficulty for the bladder to empty efficiently. In this scenario catheters are utilised, either in the form of clean intermittent catheterisation (CIC) or indwelling catheters. Little has been collated in the literature regarding the urethral complications associated with these methods of bladder drainage. We reviewed the literature of the published articles reporting on the urethral complications associated with catheter use in the spinal cord injured population. Long term, both methods carry a risk of urethral complications including tructuring, erosion, fistulation and diverticulum formation with less risk reported for CIC. Although reports of the management of these complications are limited in the literature, surgical repair forms the mainstay of management and in severe cases urinary diversion is required.K Ke ey yw wo or rd ds s: : Urethral complications; urethral erosion; urethral diverticulum; urethral stricture; urethral fistula; spinal cord injuries; clean intermittent catheterisation Ö ÖZ ZE ET T Spinal kord yaralanması, mesanenin etkin boşaltılmasında önemli güçlük çıkarabilir. Bu durumda "clean intermittent" kateterler (CIC) ve/veya "indwelling" kateterler kullanılabilir. Bu metotlarla mesanenin boşaltılmasına ilişkin üretral komplikasyonları ele alan literatürü gözden geçirdik. Spinal kord hasarı yaşamış popülasyonda kateter kullanımına ilişkin üretral komplikasyonları ele alan makaleleri derledik. Uzun dönemde, her iki kateter yönteminde de sık rastlanan komplikasyonlar erozyon, fistülasyon ve divertikulum formasyonu olmakla beraber, bu riskler CIC ile daha az rapor edilmiştir. Bu komplikasyonların yönetimine ilişkin makalelerin raporların sayısı az olmakla birlikte, bunların tedavisinde ana yöntem cerrahi onarım olmaktadır. Şiddetli olgularda üriner diversiyon gerekmektedir.A An na ah h t ta ar r K Ke e l li i m me e l le

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Progression of pressure ulcer to vesico-cutaneous fistula

Cited by 9 publications

References 8 publications

Management of urethrocutaneous fistulae complicating sacral and perineal pressure ulcer in neurourological patients: A national multicenter study from the French‐speaking Neuro‐urology Study Group and the Neuro‐urology committee of the French Association of Urology

Management of urethrocutaneous fistulae complicating sacral and perineal pressure ulcer in neurourological patients: A national multicenter study from the French‐speaking Neuro‐urology Study Group and the Neuro‐urology committee of the French Association of Urology

Management of complex ischial-urethral fistula in neurogenic patients performing clean intermittent self-catheterization

Urethral Complications in Spinal Cord Injury

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