Rectourethral fi stula: a rare complication of injection sclerotherapy

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

efficacy of tamsulosin in lower reteral calculi

There has been a paradigm shift in the management of ureteral calculi in the last decade with the introduction of new less invasive methods, such as ureterorenoscopy and extracorporeal shock wave lithotripsy [ESWL]. Recent studies have reported excellent results with medical expulsive therapy [MET] for distal ureteral calculi, both in terms of stone expulsion and control of ureteral colic pain. We conducted a comparative study in between watchful waiting and MET with tamsulosin. We conducted a comparative study in between watchful waiting [Group I] and MET with tamsulosin [Group II] in 60 patients, with a follow up of 28 days. Independent 't' test and chi-square test. Group II showed a statistically significant advantage in terms of the stone expulsion rate. The mean number of episodes of pain, mean days to stone expulsion and mean amount of analgesic dosage used were statistically significantly in Group II [P value is 0.007, 0.01 and 0.007, respectively] as compared to Group I. It is concluded that MET should be considered for uncomplicated distal ureteral calculi before ureteroscopy extracorporeal lithotripsy. Tamsulosin has been found to increase and hasten stone expulsion rates, decrease acute attacks by acting as a spasmolytic, reduces mean days to stone expulsion and decreases analgesic dose usage