Johnsen Niels V, Sosland Rachel, Kaufman Melissa R, Guillamondegui Oscar D, Dmochowski Roger R
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
Urology. 2017 Nov;109:195-200. doi: 10.1016/j.urology.2017.06.034. Epub 2017 Jul 6.
To evaluate our experience with urinary-cutaneous fistulae (UCFs) in patients following conservative management of extraperitoneal bladder ruptures (EBRs) caused by blunt trauma.
Patients with blunt-trauma related EBR who underwent primary management with urethral catheter drainage alone from 2000 to 2015 were identified in our institutional trauma registry. The demographics, the hospital courses, and the outcomes of patients who developed UCF were analyzed.
A total of 96 patients with EBR were identified, of which 56 (58%) were managed with urethral catheter drainage. 10 patients (18%) developed major urologic complications including urosepsis (2), infected pelvic hardware (1), persistent extravasation without cutaneous fistulization (1), and UCF formation (6). Of the patients with UCF, the median time to diagnosis of EBR was 1.5 days (range 0-12), whereas the median time to diagnosis of UCF was 11 days (range 3-31). Two patients developed UCF to the perineum, whereas 4 developed UCF to the thigh. Four (66.7%) underwent nonurologic operations without cystorrhaphy before the development of UCF. One patient died without a resolution of her fistula. The remaining 5 patients all required operative repair, with a median time to repair from diagnosis of 21 days (range 2-106). The median time to resolution from diagnosis was 64 days (range 35-155).
UCFs are an under-reported but morbid complication of the nonoperative management of EBR. Although rare, UCF in this setting should prompt surgical intervention given the potential for prolonged convalescence and a low probability of spontaneous resolution.
