Ennaciri Soufiane, Bitard Toufik Michel
Service d'Urologie, Centre Hospitalier Universitaire Hassan II, Fès, Maroc.
Service de Chirurgie Viscérale et Urologique, Hôpital Simone Veil, Eaubonne, France.
Pan Afr Med J. 2018 Jul 5;30:197. doi: 10.11604/pamj.2018.30.197.16037. eCollection 2018.
Urinary fistulas are a rare late complication after radiotherapy for prostate cancer. We here report the case of a 76-year old patient who had undergone radical prostatectomy 4 years before followed by external beam radiotherapy for prostate cancer. The patient presented with recurrent thigh swelling . Clinical examination showed renitent and painless mass at the level of the medial compartment of the right thigh. Ultrasound followed by CT scan showed big homogeneous fluid collection in the inner thigh exercising a slight compression on femoral vessels. Surgical drainage was performed removing 900 ml cloudy liquid whose bacteriological examination was negative. Post operative suites were marked by a sharp reduction of diuresis. However significant quantity of clear liquid continued to be drained. Given the patient's clinical picture, methylene blue test followed by retrograde cystography were performed confirming the diagnosis of fistula originating from the ureterovesical junction. The drainage of the collection was obtained through the insertion of a local probe for several weeks.
尿瘘是前列腺癌放疗后罕见的晚期并发症。我们在此报告一例76岁患者的病例，该患者4年前接受了根治性前列腺切除术，随后因前列腺癌接受了体外照射放疗。患者出现反复大腿肿胀。临床检查显示右大腿内侧间室水平有坚韧且无痛的肿块。超声检查后进行CT扫描，显示大腿内侧有大量均匀的液体积聚，对股血管有轻微压迫。进行了手术引流，引出900毫升浑浊液体，其细菌学检查为阴性。术后尿量显著减少。然而，仍有大量清亮液体持续引出。鉴于患者的临床表现，进行了亚甲蓝试验，随后进行逆行膀胱造影，证实了源于输尿管膀胱连接处的瘘管诊断。通过插入局部引流管数周来引出积液。
