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Endoscopic management of a chronic ureterocutaneous fistula using cyanoacrylic glue.

Omar M, Abdulwahab-Ahmed A, El Mahdey Ael D - Cent European J Urol (2014)

Bottom Line: A female aged 33 presented to our facility with a ureterocutaneous fistula after surgery.We used a retrograde endoscopic approach for the instillation of 2 ml of sealant into the ureteral lumen to seal the ureter and fistulous tract.The fistulous opening healed spontaneously a week after the procedure, and the patient remained dry and symptom free for 5 months following the procedure.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Menofya University, Egypt.

ABSTRACT
Ureterocutaneous fistula is a rare complication of renal surgery. Cyanoacrylate glue is a tissue adhesive, used primarily for the endoscopic control of bleeding from gastric varices. A female aged 33 presented to our facility with a ureterocutaneous fistula after surgery. We used a retrograde endoscopic approach for the instillation of 2 ml of sealant into the ureteral lumen to seal the ureter and fistulous tract. The fistulous opening healed spontaneously a week after the procedure, and the patient remained dry and symptom free for 5 months following the procedure. Endoscopic delivery of cyanoacrylate sealant was a feasible and effective way in treating a ureterocutaneous fistula in our patient.

No MeSH data available.


Related in: MedlinePlus

A fistulogram showing a fistula (arrow) from the scar to the ureter.
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Figure 0003: A fistulogram showing a fistula (arrow) from the scar to the ureter.

Mentions: On the examination of this patient, we found an obese woman, who was not in painful distress. Her vital signs were stable and her body mass index was 31 kg/m2. There were midline abdominal and left loin scars. The loin scar overlay a reducible cystic swelling that had both a visible and palpable cough impulse. There was a fistulous opening discharging clear urine at the inferior end of the scar. No associated tenderness or foul smelling discharge was present. Other aspects of examination were within normal limits. A diagnosis of post nephrectomy ureterocutaneous fistula and left lumber incisional hernia in this obese patient was made. These were confirmed by radiological investigations (Figures 3 and 4), including a micturating cystourethrogram showing grade II left ureteral reflux. We used an open–end ureteral catheter for a retrograde endoscopic approach to the left ureter. A composite of lipidol and cyanoacrylate sealant was injected into the ureteral lumen at the level of the upper third of the ureter. The amount of adhesive injected was 2 ml (1 ml lipidol + 1 ml cyanoacrylate mixture) to seal the ureter and fistula tract. Caution to avoid early polymerization of the mixture was taken by mixing the cyanoacrylate with lipidol, followed by a rapid injection of the mixture and removal of the ureteric catheter in a period of less than 15 seconds from the start of injection. The bladder was then irrigated with saline through a 25 Fr cystoscope to prevent any accidental leak back of sealant into the bladder. The fistulous opening healed spontaneously a week after the procedure, with insignificant post–void urine residual volume detected by ultrasound and the patient remained dry and symptom free for 5 months after the procedure, until she subsequently failed to appear at any further follow–ups. Written informed consent was obtained from the patient for the publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.


Endoscopic management of a chronic ureterocutaneous fistula using cyanoacrylic glue.

Omar M, Abdulwahab-Ahmed A, El Mahdey Ael D - Cent European J Urol (2014)

A fistulogram showing a fistula (arrow) from the scar to the ureter.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4310886&req=5

Figure 0003: A fistulogram showing a fistula (arrow) from the scar to the ureter.
Mentions: On the examination of this patient, we found an obese woman, who was not in painful distress. Her vital signs were stable and her body mass index was 31 kg/m2. There were midline abdominal and left loin scars. The loin scar overlay a reducible cystic swelling that had both a visible and palpable cough impulse. There was a fistulous opening discharging clear urine at the inferior end of the scar. No associated tenderness or foul smelling discharge was present. Other aspects of examination were within normal limits. A diagnosis of post nephrectomy ureterocutaneous fistula and left lumber incisional hernia in this obese patient was made. These were confirmed by radiological investigations (Figures 3 and 4), including a micturating cystourethrogram showing grade II left ureteral reflux. We used an open–end ureteral catheter for a retrograde endoscopic approach to the left ureter. A composite of lipidol and cyanoacrylate sealant was injected into the ureteral lumen at the level of the upper third of the ureter. The amount of adhesive injected was 2 ml (1 ml lipidol + 1 ml cyanoacrylate mixture) to seal the ureter and fistula tract. Caution to avoid early polymerization of the mixture was taken by mixing the cyanoacrylate with lipidol, followed by a rapid injection of the mixture and removal of the ureteric catheter in a period of less than 15 seconds from the start of injection. The bladder was then irrigated with saline through a 25 Fr cystoscope to prevent any accidental leak back of sealant into the bladder. The fistulous opening healed spontaneously a week after the procedure, with insignificant post–void urine residual volume detected by ultrasound and the patient remained dry and symptom free for 5 months after the procedure, until she subsequently failed to appear at any further follow–ups. Written informed consent was obtained from the patient for the publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.

Bottom Line: A female aged 33 presented to our facility with a ureterocutaneous fistula after surgery.We used a retrograde endoscopic approach for the instillation of 2 ml of sealant into the ureteral lumen to seal the ureter and fistulous tract.The fistulous opening healed spontaneously a week after the procedure, and the patient remained dry and symptom free for 5 months following the procedure.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Menofya University, Egypt.

ABSTRACT
Ureterocutaneous fistula is a rare complication of renal surgery. Cyanoacrylate glue is a tissue adhesive, used primarily for the endoscopic control of bleeding from gastric varices. A female aged 33 presented to our facility with a ureterocutaneous fistula after surgery. We used a retrograde endoscopic approach for the instillation of 2 ml of sealant into the ureteral lumen to seal the ureter and fistulous tract. The fistulous opening healed spontaneously a week after the procedure, and the patient remained dry and symptom free for 5 months following the procedure. Endoscopic delivery of cyanoacrylate sealant was a feasible and effective way in treating a ureterocutaneous fistula in our patient.

No MeSH data available.


Related in: MedlinePlus