Browsing by Subject "Fistula"

Now showing 1 - 3 of 3
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    Delayed presentation of urethrocutaneous fistulae after hypospadias repair.
    (Journal of pediatric surgery, 2020-01-29) Johnston, Ashley W; Jibara, Ghalib A; Purves, J Todd; Routh, Jonathan C; Wiener, John S
    BACKGROUND:Delayed urethrocutaneous fistula (UCF) presentation after hypospadias repair is rarely reported. The aim of this study is to report our experience with delayed UCF presenting more than 5 years after hypospadias repair. METHODS:We conducted a retrospective review of patients who underwent UCF repair (CPT codes 54,340 and 54,344) at our institution between 1997 and 2017. Delayed UCF presentation was defined as a single normal urinary stream after initial hypospadias repair and subsequent presentation of a UCF/s urinary stream more than 5 years after initial hypospadias or UCF repair. Demographic and clinical data were reviewed after approval from our institutional review committee. RESULTS:We identified 12 patients with delayed UCF. The mean age at hypospadias repair was 12.3 months (Range 6-32). The mean time to delayed UCF presentation was 11.5 years (Range 7.1-15.8). Four patients with delayed UCF (33.3%) required additional surgery for UCF recurrence with a mean time to recurrence of 2.2 years (Range < 1-5.6). CONCLUSIONS:Delayed UCF presentation can occur more than 15 years after initial repair. Pubertal penile skin changes and increased genital awareness in older children may be contributing factors as all but one presented at age 10 years or older. LEVEL OF EVIDENCE:III.
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    Extirpative cultures reveal infectious pubic bone osteomyelitis in prostate cancer survivors with urinary-pubic symphysis fistulae (UPF).
    (Urology, 2020-05-07) Nosé, Brent D; Boysen, William R; Kahokehr, Arman A; Inouye, Brian M; Eward, William C; Hendershot, Edward F; Peterson, Andrew C
    OBJECTIVE:To examine the infectious features of patients with urinary pubic symphysis fistula (UPF) and their association with osteomyelitis. METHODS:We conducted a review of our quality improvement database for 36 patients with UPF undergoing bone resection and extirpative surgery from October 2012 to January 2019. An assessment of bone and urine cultures was carried out along with surgical, radiologic and demographic data. We analyzed descriptive statistics and used Fisher Exact Tests and unpaired Welch t-tests to assess for associations with positive bone cultures. RESULTS:In our cohort, 33 patients (91.7%) had positive bone cultures with the three most common organisms being candida (22.0%), enterococcus (18.0%) and pseudomonas (10.0%). There was a correlation between positive pre-operative urine culture and positive bone culture (p< 0.01), with 63.0% of those with positive urine cultures growing the same organism on bone culture. CONCLUSIONS:In this series, 91.7% of patients undergoing extirpative surgery for UPF at our institution have positive bone cultures at time of pubic bone debridement. Additionally, we demonstrate a statistically significant correlation between positive urine cultures and positive bone cultures in these patients. This supports the need for a multidisciplinary approach including infectious disease, orthopedic surgery and reconstructive urology in order to address this complex clinical condition.
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    Primary aortoduodenal fistula caused by severe atherosclerosis, not by aneurysm.
    (The American journal of cardiovascular pathology, 1993-01) Gallagher, DM; Mendelson, T; Krupski, WC; Finkbeiner, WE
    Primary aortoduodenal fistula is an uncommon cause of massive upper gastrointestinal hemorrhage usually due to pressure erosion of an abdominal aortic aneurysm into the third portion of the duodenum. This report describes a case of a 59-year-old man who died of massive gastrointestinal hemorrhage due to a primary aortoduodenal fistula. This case is unique in that the fistula formed as a result of complex atherosclerotic disease of the abdominal aorta, with adventitial chronic inflammation and foreign body reaction against atheromatous plaque, and not from an aneurysm. We were unable to identify any other reports of aortoduodenal fistulas developing spontaneously in the absence of aneurysmal disease of the aorta.