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Bladder reconstruction using bovine pericardium in a case of enterovesical fistula.

Moon SJ, Kim DH, Jo JK, Chung JH, Lee JY, Park SY, Kim YT, Park HK, Choi HY, Moon HS - Korean J Urol (2011)

Bottom Line: The use of graft materials in bladder mucosa has been examined in animal models, but debate exists over which materials are effective.Intestine has been used as a substitute in augmentation cystoplasty for patients with neuropathic bladder, but serious adverse effects of the operation have occurred in some instances.The patient has remained well for 2.5 years.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Hanyang University College of Medicine, Seoul, Korea.

ABSTRACT
The use of graft materials in bladder mucosa has been examined in animal models, but debate exists over which materials are effective. Intestine has been used as a substitute in augmentation cystoplasty for patients with neuropathic bladder, but serious adverse effects of the operation have occurred in some instances. We report a case of a successful repair of an enterovesical fistula by use of bovine pericardium. The patient has remained well for 2.5 years. We suggest that bovine pericardium may be a suitable option as a bladder substitute.

No MeSH data available.


Related in: MedlinePlus

Cystography revealed a fistula tract between the contracted urinary bladder and the terminal ileum.
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Figure 1: Cystography revealed a fistula tract between the contracted urinary bladder and the terminal ileum.

Mentions: Under the presumptive diagnosis of an enterovesical fistula, cystography was performed. In the cystography, the dye instilled into the bladder was seen to enter the terminal ileum (Fig. 1). Under the diagnosis of an enterovesical fistula, cystoplasty was planned. In the field of the operation, severe adhesion of the bladder wall to the pelvic wall was seen, and the bladder wall was in a crumbling state. Adhesion of the intestine was very severe, and it was very difficult to dissect the fistula site. A general surgeon resected the fistula site and anastomosed the colon. Thereafter, the defect of the dome site of the bladder wall was identified and measured at 2.4×2 cm (Fig. 2A). We tried to anastomose the defect, but it was too large to repair, and the bladder wall had no elasticity. Therefore, it was impossible to close the defect, and augmentation cystoplasty using the intestine was contraindicated because of the poor state of the intestine due to the previous radiation therapy. Therefore, we decided to repair the bladder wall defect with BP (Supple Peri-Guard®, Synovis®). In the operating room, we explained to the patient's son the state of the patient's bladder and intestine and about the uncertain safety of BP and possible complications after operation with BP. He agreed to the operation using BP and we started the operation. We tailored the BP to the size of the defect and closed the site with Vicryl 3-0 (Fig. 2B). After the operation, a 16 Fr Foley catheter was inserted into the bladder. When we performed cystography in postoperative weeks 3 and 6, dye leakage was seen, but by postoperative week 8 it was no longer observed, although vesicoureteral reflux and contracted bladder remained. We tried to persuade the patient to remove the Foley catheter and to undertake self-voiding. However, the patient was worried about the recurrence of severe voiding difficulty including frequency and urgency and did not permit the removal of the Foley catheter. The patient retained the urethral Foley catheter when she was discharged and we changed it every month. Six months after the operation, we again performed a cystoscopy and the BP was intact. At postoperative year 1, we removed the catheter. We persuaded the patient to undertake self-voiding and prescribed tolterodine 4 mg to control frequency. After administration of tolterodine for three days, she complained of abdominal distension and pain. Under the diagnosis of functional bowel obstruction due to the side effect of the anticholinergic action of tolterodine, conservative management was done for the bowel obstruction. The patient recovered without complications. After that, she refused further administration of anticholinergics because of the expected side effect of the drug. Her frequency problems still remained, so she wanted to restore the urethral Foley catheter to relieve the voiding symptoms and to change it every month instead of self-voiding with medication. The patient was followed every month in our clinic. Her follow-up blood urea/nitrogen level was 29/2.1 mg/dl. Cystoscopy was performed postoperatively 2.5 years later. The BP observed at the dome of the bladder wall remained intact (Fig. 3).


Bladder reconstruction using bovine pericardium in a case of enterovesical fistula.

Moon SJ, Kim DH, Jo JK, Chung JH, Lee JY, Park SY, Kim YT, Park HK, Choi HY, Moon HS - Korean J Urol (2011)

Cystography revealed a fistula tract between the contracted urinary bladder and the terminal ileum.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3045723&req=5

Figure 1: Cystography revealed a fistula tract between the contracted urinary bladder and the terminal ileum.
Mentions: Under the presumptive diagnosis of an enterovesical fistula, cystography was performed. In the cystography, the dye instilled into the bladder was seen to enter the terminal ileum (Fig. 1). Under the diagnosis of an enterovesical fistula, cystoplasty was planned. In the field of the operation, severe adhesion of the bladder wall to the pelvic wall was seen, and the bladder wall was in a crumbling state. Adhesion of the intestine was very severe, and it was very difficult to dissect the fistula site. A general surgeon resected the fistula site and anastomosed the colon. Thereafter, the defect of the dome site of the bladder wall was identified and measured at 2.4×2 cm (Fig. 2A). We tried to anastomose the defect, but it was too large to repair, and the bladder wall had no elasticity. Therefore, it was impossible to close the defect, and augmentation cystoplasty using the intestine was contraindicated because of the poor state of the intestine due to the previous radiation therapy. Therefore, we decided to repair the bladder wall defect with BP (Supple Peri-Guard®, Synovis®). In the operating room, we explained to the patient's son the state of the patient's bladder and intestine and about the uncertain safety of BP and possible complications after operation with BP. He agreed to the operation using BP and we started the operation. We tailored the BP to the size of the defect and closed the site with Vicryl 3-0 (Fig. 2B). After the operation, a 16 Fr Foley catheter was inserted into the bladder. When we performed cystography in postoperative weeks 3 and 6, dye leakage was seen, but by postoperative week 8 it was no longer observed, although vesicoureteral reflux and contracted bladder remained. We tried to persuade the patient to remove the Foley catheter and to undertake self-voiding. However, the patient was worried about the recurrence of severe voiding difficulty including frequency and urgency and did not permit the removal of the Foley catheter. The patient retained the urethral Foley catheter when she was discharged and we changed it every month. Six months after the operation, we again performed a cystoscopy and the BP was intact. At postoperative year 1, we removed the catheter. We persuaded the patient to undertake self-voiding and prescribed tolterodine 4 mg to control frequency. After administration of tolterodine for three days, she complained of abdominal distension and pain. Under the diagnosis of functional bowel obstruction due to the side effect of the anticholinergic action of tolterodine, conservative management was done for the bowel obstruction. The patient recovered without complications. After that, she refused further administration of anticholinergics because of the expected side effect of the drug. Her frequency problems still remained, so she wanted to restore the urethral Foley catheter to relieve the voiding symptoms and to change it every month instead of self-voiding with medication. The patient was followed every month in our clinic. Her follow-up blood urea/nitrogen level was 29/2.1 mg/dl. Cystoscopy was performed postoperatively 2.5 years later. The BP observed at the dome of the bladder wall remained intact (Fig. 3).

Bottom Line: The use of graft materials in bladder mucosa has been examined in animal models, but debate exists over which materials are effective.Intestine has been used as a substitute in augmentation cystoplasty for patients with neuropathic bladder, but serious adverse effects of the operation have occurred in some instances.The patient has remained well for 2.5 years.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Hanyang University College of Medicine, Seoul, Korea.

ABSTRACT
The use of graft materials in bladder mucosa has been examined in animal models, but debate exists over which materials are effective. Intestine has been used as a substitute in augmentation cystoplasty for patients with neuropathic bladder, but serious adverse effects of the operation have occurred in some instances. We report a case of a successful repair of an enterovesical fistula by use of bovine pericardium. The patient has remained well for 2.5 years. We suggest that bovine pericardium may be a suitable option as a bladder substitute.

No MeSH data available.


Related in: MedlinePlus