Standards in high intenstinal fistulae after urogenital system reconstructive operations
Article published in Urologia Polska 2008/61/Supl. 1.

authors

Witold Mikołajczak, Jerzy Siekiera, Wojciech Zegarski, Michał Klag, Andrzej Petrus, Krzysztof Kamecki, Andrzej Wronczewski

Oddział Urologii Onkologicznej, Centrum Onkologii im. prof. F. Łukaszczyka w Bydgoszczy

summary

Introduction.

Intestinal fistulae are aabnormal passages from the intestine to either an internal organ or the body surface. Their treatment remains a challenge, as it is connected with high mortality risk, difficult diagnosing, long treatment time and cost, as well as with difficult decision regarding surgical reintervention.

Objectives.

Evaluation of standards in cases of high intestinal fistulae after urogenital system reconstruction surgery using small intestine.

Materials and methods.

Intestinal fistulae in oncological patients are more often postoperative (75-85%) than idiopathic (less than 25%). Intestinal leak usually occurs 5-7 days after operation. It may be preceded by pain, fever, leucocytosis or peristalsis disorder. 74 radical cystectomies because of bladder cancer were performed in Oncological Urology Department in years 2006-2007. In four of them intestinal-cutaneous fistulae occured. Initially, all of them were treated conservatively. One of them died, in one fistula closed without surgical intervention and two were operated. Decision was based on lack of effect of conservative treatment. In one of them postoperative course was without complications and fistula was closed, in the second one intestinal-cutaneous fistula recurred. This patient was again treated conservatively and operated

again after a few months with good effect. Conservative treatment included: regulation of electrolytes homeostasis, reduction of content excreted through fistula, hyperalimentation, abscesses drainage, treating the infection of cutaneous orifice of the fistula, respiratory rehabilitation, complications (peptic ulcer, infections) prevention, broad-spectrum antibiotics and then antibiotic therapy guided by antibiogram results, psychological care, daily estimation of treatment progress.

Results.

In three patients (75%) fistula was cured, one died because of neoplasm advance. Conservative treatment significantly reduced excretion through fistula, which had a direct influence on patients’ quality of life.

Conclusion.

Intestinal fistulae remain a serious clinical problem. Treatment standard introduced in Oncological Surgery Department and Oncological Urology Department allowed to obtain goog clinical results.