Hamdy Omar, Abdelghaffar Eman A, Alalawi Zainab S, Eid Ahmed M, Saleh Gehad Ahmad
Surgical Oncology Department, Oncology Center, Mansoura University, Mansoura, Egypt.
Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Int J Surg Case Rep. 2024 Dec;125:110639. doi: 10.1016/j.ijscr.2024.110639. Epub 2024 Nov 22.
Orthotopic neobladder reconstruction may be associated with complications such as neobladder-vaginal fistula (NVF) and uretero-ileal anastomotic stricture which are often managed using stents, though these can be prone to migration.
We present a 69-year-old lady with a surgical history of radical cystectomy and ileal neobladder that was complicated by a left ureteric stricture and poucho-vaginal fistula for which she underwent a left ureteric stent and bilateral percutaneous nephrostomy (PCN) insertions after which she lost to follow-up. The patient later presented to our center with a right subcostal anterior abdominal wall desmoid tumor for which she underwent wide local excision. During the pre-operative catheterization, a stony hard object was identified within the vaginal cavity. Examination under anesthesia revealed large stones that developed on the migrated stent which was extracted along with five large stones.
The most common endoscopically treated neobladder-related late complications are uretero-ileal anastomotic stricture and calculus development. The presented patient developed two of these complications which are left ureteric stricture as well as a poucho-vaginal fistula. Meanwhile, the most difficult complication related to ureteral stents is retained stents and their sequelae including encrustation. About 3.6-10 % of women experience NVF after orthotropic neobladder reconstruction. To the best of our knowledge, this is the first case ever to be presented by such a presentation.
Our presented case underscores the importance of prompt detection and proactive management of complications after ileal neobladder reconstruction which can prevent the development of more complications and save the patients from unexpected scenarios.
原位新膀胱重建可能会伴有诸如新膀胱 - 阴道瘘（NVF）和输尿管 - 回肠吻合口狭窄等并发症，这些并发症通常使用支架进行处理，不过支架容易移位。
我们报告一名69岁女性，有根治性膀胱切除术和回肠新膀胱的手术史，并发左输尿管狭窄和膀胱阴道瘘，为此她接受了左输尿管支架置入和双侧经皮肾造瘘术（PCN），之后失访。该患者后来因右肋下前腹壁硬纤维瘤就诊于我们中心，并接受了广泛局部切除。在术前导尿期间，在阴道腔内发现一个坚硬如石的物体。麻醉下检查发现，移位的支架上形成了大结石，连同五块大结石一起被取出。
内镜治疗的最常见新膀胱相关晚期并发症是输尿管 - 回肠吻合口狭窄和结石形成。该患者出现了其中两种并发症，即左输尿管狭窄和膀胱阴道瘘。同时，与输尿管支架相关的最棘手并发症是支架留存及其后遗症，包括结石形成。约3.6 - 10%的女性在原位新膀胱重建后会发生NVF。据我们所知，这是首例如此表现的病例。
我们报告的病例强调了回肠新膀胱重建后及时发现并积极处理并发症的重要性，这可以预防更多并发症的发生，使患者避免意外情况。
