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BJU International 2000 86 (7), 910
CASE REPORTS
A unique treatment for an unusual fistula
G.
Lee1, N.
Christopher1, M.
Kellett1 and P.J.R.
Shah*
1 The Middlesex Hospital and * The Institute of Urology and Nephrology, London, UK
Case report
Comment  References Authors A 45-year-old man presented with Dukes’ B adenocarcinoma of the sigmoid colon infiltrating the bladder. Primary treatment was an anterior resection and partial cystectomy with adjuvant radiotherapy (50 Gy and chemotherapy with 5-fluorouracil). Six weeks after surgery the patient developed a vesico-rectal fistula. Attempted surgical repair was abandoned because of excessive benign pelvic fibrosis. Instead, a urinary diversion was effected with an ileal conduit and the fecal stream diverted with an end colostomy. However, within 2 weeks the patient was again passing urine rectally. A loopogram revealed a communication between the proximal end of the conduit and the left distal ureteric stump, with contrast medium entering the rectum via the original fistula (Fig. 1). Conservative treatment with nephrostomy drainage and ureteric stents failed to resolve the rectal leak. At cystoscopy the ureteric stump was filled retrogradely with synthetic tissue adhesive (butyl-2-cyanoacrylate injected rapidly in a ‘sandwich’ of glucose solution [1,2]). The ureteric orifice was then obstructed using the STING procedure with a 2.5 mL peri-ureteric injection of polydimethylsiloxane [3] (MacroplastiqueTM Uroplasty Inc., Reading, UK) to prevent loss of the adhesive. The rectal leak dried over the next 4 weeks and the ureteric stents were removed. The patient has had no further urinary leak.
Comment
Case report  References Authors A complex communication between an ileal conduit and a vesico-rectal fistula via the ureteric stump has not previously been reported. The endoscopic use of tissue adhesives and bulking-agent injections to obstruct such fistulae appears to be safe, simple and effective.
References
Case report Comment Authors
Authors
Case report Comment G. Lee, MA, MRCS, SHO Urology.
N. Christopher, MPhil, FRCS, Specialist Registrar.
M. Kellett, MA, FRCR, Consultant Radiologist.
P.J.R. Shah, FRCS, Senior Lecturer, Consultant Urologist.
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| To cite this article |
| Lee, G., Christopher, N., Kellett, M. & Shah, P.J.R. A unique treatment for an unusual fistula.
BJU International 2000 86 (7), 910
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Lee, G
Christopher, N
Kellett, M
Shah, P
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| Correspondence: P.J.R. Shah, The Institute of Urology and Nephrology and St Peter’s Hospital, The Middlesex Hospital, Mortimer Street, London, W1N 8AA, UK. |
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