A 23-year-old man had a history of intermittent episodes of urinary tract infection with associated low abdominal pain for 15 years. Persistent bacteriuria even with prolonged antibiotics was the reason why he was referred to our hospital. Laboratory tests were normal except pyuria and growth of Escherichia coli in the urinary samples. Cystoscopy revealed a small slit-like opening on the right lateral wall of bladder dome. We found some air within the bladder and a suspicious communicating tract between the appendix and bladder on a CT scan. With a strong impression of appendicovesical fistula, a laparoscopy was performed to confirm a diagnosis and to remove the appendicovesical fistula resulting in a satisfactory result without any complication.
Adult ; Appendix/*surgery ; Humans ; Laparoscopy/*methods ; Male ; Urinary Bladder/surgery ; Urinary Bladder Fistula/*surgery ; Urinary Tract Infections/etiology/surgery ; Young Adult

ObjectiveTo compare the effect of inlaid labial mucosal graft repair (LMGR) with that of bladder mucosal graft repair (BMGR) in the treatment of complex urethral skin fistula after hypospadias repair.

METHODSThis study included 55 cases of complex urethral skin fistula following hypospadias repair. We randomly assigned them to receive inlaid LMGR (n=36) or BMGR (n=19). After surgery, we compared the incidence of complications and recurrence rate of urinary fistula between the two groups of patients.

RESULTSThe success rates of operation were 91.7% and 84.2% in the LMGR and BMGR groups, respectively, and the penile appearance was desirable in both groups. Postoperative complications included 2 cases of urinary fistula and 1 case of urethral stricture in each group. There were no statistically significant differences between the two groups in the success rate of operation (P>0.05) or the incidence rate of postoperative complications (P>0.05).

CONCLUSIONSBoth inlaid LMGR and BMGR yield satisfactory results in the treatment of complex urethral skin fistula. However, LMGR involves less injury in mucosa collection and is easier to perform and therefore deserves more clinical attention.

Cutaneous Fistula ; surgery ; Humans ; Hypospadias ; surgery ; Incidence ; Male ; Postoperative Complications ; Reconstructive Surgical Procedures ; Recurrence ; Urethra ; surgery ; Urinary Bladder ; surgery ; Urinary Fistula ; surgery ; Urologic Surgical Procedures, Male

Objective: To investigate the efficacy and safety of pedunculated rectus abdominis combined with bilateral ureteral extravestheter drainage in the treatment of refractory bladder-vaginal stump fistula. Methods: The clinical data of 8 cases of the refractory bladder-vaginal stump fistula were admitted to the Second Hospital of Hebei Medical University and Henan Cancer Hospital and underwent the clinical treatment of bladder-vaginal stump from December 2019 to December 2022 were collected. The reason of refractory bladder-vaginal stump fistula was analyzed, the operation manner of pedunculated rectus abdominis combined with peduncle and bilateral ureter for the treatment of bladder-vaginal stump through extrabladder drainage was explored. The operation time, bleeding volume and clinical effect were record. Results: The median operation time of 8 patients was 150 minutes(120~180 min), and the median blood loss was 400 ml(200~600 ml). During the perioperative period, there were 2 cases of incision infection, delayed healing by debridement and dressing, 2 cases of incision rupture and suture wound healing after reoperation, and 2 cases of urinary tract infection were cured by anti-infection. When followed up for 6 months, 8 cases of vesicovaginal stump fistula were cured. Conclusion: Bilateral ureteral external drainage of the rectus abdominis muscle, has a practical effect in the treatment of refractory bladder-vaginal stump fistula, which can be one of the clinical repairing treatment.
Female ; Humans ; Urinary Bladder/surgery* ; Ureter/surgery* ; Rectus Abdominis ; Drainage ; Fistula

Objective: To investigate the efficacy and safety of pedunculated rectus abdominis combined with bilateral ureteral extravestheter drainage in the treatment of refractory bladder-vaginal stump fistula. Methods: The clinical data of 8 cases of the refractory bladder-vaginal stump fistula were admitted to the Second Hospital of Hebei Medical University and Henan Cancer Hospital and underwent the clinical treatment of bladder-vaginal stump from December 2019 to December 2022 were collected. The reason of refractory bladder-vaginal stump fistula was analyzed, the operation manner of pedunculated rectus abdominis combined with peduncle and bilateral ureter for the treatment of bladder-vaginal stump through extrabladder drainage was explored. The operation time, bleeding volume and clinical effect were record. Results: The median operation time of 8 patients was 150 minutes(120~180 min), and the median blood loss was 400 ml(200~600 ml). During the perioperative period, there were 2 cases of incision infection, delayed healing by debridement and dressing, 2 cases of incision rupture and suture wound healing after reoperation, and 2 cases of urinary tract infection were cured by anti-infection. When followed up for 6 months, 8 cases of vesicovaginal stump fistula were cured. Conclusion: Bilateral ureteral external drainage of the rectus abdominis muscle, has a practical effect in the treatment of refractory bladder-vaginal stump fistula, which can be one of the clinical repairing treatment.
Female ; Humans ; Urinary Bladder/surgery* ; Ureter/surgery* ; Rectus Abdominis ; Drainage ; Fistula

Adenocarcinoma ; complications ; Aged ; Colonic Diseases ; etiology ; surgery ; Humans ; Intestinal Fistula ; etiology ; surgery ; Male ; Sigmoid Neoplasms ; complications ; Urinary Bladder Fistula ; etiology ; surgery

OBJECTIVE: This study was designed to assess the usefulness of transperineal ultrasonography (US) for the determination of imperforate anus (IA) type. MATERIALS AND METHODS:From January 2000 to December 2004, 46 of 193 patients with an IA underwent transperineal US prior to corrective surgery. Sonographic findings were reviewed to identify the presence of internal fistulas and to determine "distal rectal pouch to perineum (P-P)" distances. IA types were determined based on the sonographic findings, and the diagnostic accuracy of transperineal US was evaluated based on surgical findings. RESULTS: Of the 46 patients, 17 patients were surgically confirmed as having a high-type IA, three patients were confirmed as having an intermediate-type IA and 26 patients were confirmed as having a low-type IA. The IA type was correctly diagnosed by the use of transperineal US in 39 of the 46 patients (85%). In 14 of the 17 patients with a high-type IA, internal fistulas were correctly identified. All cases with a P-P distance > 16 mm were high-type IAs and all cases with a P-P distance < 5 mm were low-type IAs. CONCLUSION: Transperineal US is a good diagnostic modality for the identification of internal fistulas in cases of high-type IA and for defining the IA level.
Anus, Imperforate/classification/surgery/*ultrasonography ; Female ; Fistula/ultrasonography ; Humans ; Infant, Newborn ; Male ; Rectal Fistula/ultrasonography ; Ultrasonography/methods ; Urinary Bladder Diseases/ultrasonography

OBJECTIVETo compare the therapeutic effects among moxibustion, local hot compress and infrared irradiation on urinary retention after hemorrhoid and fistula operation so as to provide the clinical evidences for the promotion and application of moxibustion.

METHODSThe randomized controlled trial method was adopted to divide 60 cases of post-operative urinary retention into moxibustion group, hot compress group and infrared irradiation group, 20 cases in each group. In moxibustion group, suspending moxibustion was applied on Qihai (CV 6) and Zhongji (CV 3). In hot compress group, hot compress was applied on the bladder region above the symphysis pubis of the lower abdomen. In infrared irradiation group, MF-C701 multi-source infrared apparatus was used on the bladder region above the symphysis pubis of the lower abdomen. One intervention therapy was administered for the cases of post-operative urinary retention. The efficacy was assessed based on the numbers of urethral catheterization indwelled in 24 h after treatment.

RESULTSThere were 2 cases (10.0%) with urethral catheterization in moxibustion group, 10 cases (50.0%) in hot compress group and 9 cases (45.0%) in infrared irradiation group. The urethral catheterization rate in moxibustion group was lower than that of the other two treatment programs (both P < 0.05).

CONCLUSIONMoxibustion can reduce much effectively the rate of urethral catheterization indwelled for urinary retention after hemorrhoid and fistula operation as compared with local hot compress therapy and infrared irradiation on the lower abdomen.

Adult ; Female ; Hemorrhoids ; surgery ; Humans ; Male ; Middle Aged ; Moxibustion ; Postoperative Complications ; therapy ; Urinary Bladder Fistula ; etiology ; therapy ; Urinary Retention ; etiology ; therapy ; Young Adult

BACKGROUNDEpidural lidocaine can be used when regional anesthesia needs to be established quickly, but the effect of co-administering epidural fentanyl on the minimum local analgesic concentration (MLAC) of lidocaine is not known. We compared the MLAC of epidural lidocaine in combination with different doses of fentanyl for epidural anesthesia in adults.

METHODSOne hundred and twenty patients requiring epidural analgesia were randomly allocated to receive 20 ml of one of four solutions: lidocaine, or lidocaine plus fentanyl 1 µg/ml, 2 µg/ml, or 3 µg/ml. The first patient in each group was administered 1% lidocaine weight by volume; subsequent patients received a concentration determined by the response of the previous patient to a higher or lower concentration according to up and down sequential allocation in 0.1% increments. Efficacy was assessed using a visual analog pain scale, and accepted if this was = 10 mm on a 100 mm scale within 30 minutes. The extent of motor block and of nausea and vomiting were recorded at 30 minutes after administration of the epidural solution and two hours after surgery, respectively.

RESULTSThe MLAC of lidocaine in those receiving lidocaine alone was 0.785% (95%CI 0.738 - 0.864). A significant dose-dependent reduction was observed with the addition of fentanyl: the MLAC of lidocaine with fentanyl at 2 µg/ml was 0.596% (95%CI 0.537 - 0.660) and 0.387% with fentanyl at 3 µg/ml (95%CI 0.329 - 0.446, P < 0.001).

CONCLUSIONEpidural fentanyl significantly reduces the dose of lidocaine required for effective epidural analgesia in adults without causing adverse side effects.

Adult ; Analgesia, Epidural ; methods ; Drug Interactions ; Female ; Fentanyl ; administration & dosage ; therapeutic use ; Fistula ; surgery ; Hemorrhoidectomy ; Humans ; Lidocaine ; administration & dosage ; therapeutic use ; Male ; Middle Aged ; Urinary Bladder Neoplasms ; surgery

OBJECTIVESTo evaluate the relationship between the operative methods and the therapeutic results of the patients with hypospadias.

METHODSNine operative types and different tissue materials taken in hypospadias operations in the past 12 years were retrospectively analyzed.

RESULTSThe operative types and tissue materials had significantly effects on the therapeutic results besides the clinical experience of the operators. The cure rates of Tunneltron Urethroplasty, Preputial island flap urethroplasty and Bladder mucosa graft urethroplasty were 86.4%, 83.3% and 83.0% respectively.

CONCLUSIONSAll the nine types and different tissue materials of Hypospadias operations have its own advantages and disadvantages. They are worth further study and improvement.

Adolescent ; Adult ; Child ; Child, Preschool ; Humans ; Hypospadias ; surgery ; Infant ; Male ; Mucous Membrane ; transplantation ; Penis ; surgery ; Surgical Flaps ; Treatment Outcome ; Urethral Stricture ; surgery ; Urinary Bladder ; transplantation ; Urinary Fistula ; surgery ; Urologic Surgical Procedures, Male ; methods

The authors report a case of bladder fistula associated with a medial thigh cutaneous fistula and chronic osteomyelitis of the pubic bone 11 years after surgery for a pelvic bone fracture and bladder rupture. In the presenting case, despite the clinical suspicion, none of the diagnostic tools demonstrated the bladder fistula preoperatively. This case suggests that bladder repair should be prepared, even if the bladder fistula cannot be confirmed by imaging studies because the amount of urine leakage can be minimal or the fistula can close spontaneously.
Abscess/complications/*diagnosis ; Cutaneous Fistula/complications/*diagnosis/radiography/surgery ; Groin ; Humans ; Male ; Middle Aged ; Osteomyelitis/complications/*diagnosis/radiography ; Pelvis/radiography ; *Pubic Bone/surgery ; Urinary Bladder Fistula/complications/*diagnosis/radiography/surgery