Clinical Presentation, Management and Outcome in Diverticular Colovesical Fistulas - Our Experience.

Colovesical fistula (CVF) is an abnormal communication between the urinary bladder and the large intestine, usually sigmoid colon. Diverticulitis is the most common cause of CVF in most of the western studies, accounting for approximately 70% of cases. Diverticular CVF is uncommon in Asia. This case series shares the experience of six cases of diverticular CVF in Indian population. METHODSMedical records of six patients with diverticular colovesical fistulas during the period January 2016 - August 2019 were reviewed with regard to symptoms, diagnostic investigations, and management. Various aspects of the disease were analysed to determine the common features of colovesical fistula in our population. RESULTSAll patients with diverticular colovesical fistula were presented with urinary symptoms and none were aware about their existing colonic diverticulosis. Five out of the six cases presented with pneumaturia. Contrast enhanced computed tomography (CECT) abdomen detected sigmoid diverticulosis with vesical fistula in all cases. The most common site of fistula found on cystoscopy was on the left superolateral wall of bladder. All cases were operated as a single stage procedure including fistula repair, colonic resection, omental interposition with no temporary colostomy which provided an excellent surgical cure. CONCLUSIONSColovesical fistula secondary to diverticular disease has shown a rising incidence and can be effectively managed by a multidisciplinary team. It requires prompt diagnosis, adequate preoperative evaluation, perioperative care including bowel preparation, nutritional supplementation, appropriate antibiotics, and meticulous surgical skills allowing an elective one-stage approach.

Single stage hypospadias repair: Experience of 76 cases / 대한비뇨기과학회지

To evaluate the efficacy of single stage repair of hypospadias, the results of 76 patients were compared to those of 45 patients who had staged repair during the period of the last 22 years. Cases of single stage repair were tremendously increased in recent years (13 patients before 1987, 63 patients after 1987). The success rate was much better than that of staged repair (single stage: 63.1 %, staged: 28.9 %). Among 45 patients who had staged repair. 17 patients (53.1 %) underwent multiple surgical corrections due to troublesome stricture, fistula and remnant chordee, and 9 patients (20 %) required additional meatal advancement due to coronal or subcoronal neomeatus. In conclusion, single stage hypospadias repair could be applicable in most cases of hypospadias and the results were superior to those of staged repair. The complications and morbidity were minimal.