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直肠尿道瘘:注射硬化治疗的一种罕见并发症。

Rectourethral fistula: A rare complication of injection sclerotherapy.

作者信息

Tanwar Raman, Singh Santosh Kumar, Pawar Devendra Singh

机构信息

Department of Urology, Pt. B. D. Sharma PGIMS, Rohtak, Haryana, India.

出版信息

Urol Ann. 2014 Jul;6(3):261-3. doi: 10.4103/0974-7796.134298.

Abstract

In the modern era, the incidence of rectourethral fistula (RUF) has been on a rise due to an increasing number of surgeries being performed for prostatic carcinoma. Other causes of this condition still remain rare and their management differs from that of post prostatectomy RUF. We report a rare case of a young man who presented with leakage of urine per rectum 4 weeks after injection sclerotherapy for haemorrhoids. A Micturating Cystourethrogram/Retrograde Cystourethrogram revealed the presence of RUF arising at the level of prostrato-membranous urethra and the urine examination did not show any fecal contamination of urine. A fistula at the level or verumontanum along with stricture of the distal penile urethra was demonstrated on urethroscopy. The patient was successfully managed by dilatation of the stricture segment and urethral catheterization. RUF can rarely result from injection sclerotherapy and must be thoroughly evaluated. Cases which present early and have minimal contamination of urine by fecal contents can be conservatively managed with a simple Foleys catheterization for 4-6 weeks after ruling out any obstruction distal to the fistulous tract.

摘要

在现代,由于前列腺癌手术数量的增加,直肠尿道瘘(RUF)的发病率一直在上升。这种情况的其他病因仍然罕见,其治疗方法与前列腺切除术后RUF不同。我们报告一例罕见病例,一名年轻男性在痔疮硬化剂注射治疗4周后出现经直肠漏尿。排尿性膀胱尿道造影/逆行膀胱尿道造影显示,RUF发生在前列腺膜部尿道水平,尿液检查未显示尿液有任何粪便污染。尿道镜检查显示精阜水平存在瘘管,同时伴有阴茎尿道远端狭窄。通过狭窄段扩张和尿道插管,该患者得到了成功治疗。RUF很少由硬化剂注射引起,必须进行全面评估。对于早期出现且粪便内容物对尿液污染最小的病例,在排除瘘管远端任何梗阻后,可通过简单的Foley导管插入术进行4 - 6周的保守治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/09d4/4127870/67c119a9fbf1/UA-6-261-g001.jpg

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