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2.
J Crohns Colitis ; 10(6): 657-62, 2016 Jun.
Article in English | MEDLINE | ID: mdl-26786982

ABSTRACT

BACKGROUND AND AIMS: The aims of this study were to evaluate the frequency of entero-urinary fistulas in a cohort of Crohn's disease (CD) patients and to analyse the outcomes of medical and surgical therapy. METHODS: This multicentre retrospective study included all CD patients with entero-urinary fistulas diagnosed by the presence of clinical symptoms and confirmed at surgery or by radiological or endoscopic techniques. We evaluated outcomes of medical and surgical therapy. We defined remission as absence of clinical symptoms with a radiological confirmation of fistula closure. Cox regression analysis was performed to evaluate factors predictive of achieving remission without need for surgery. RESULTS: Of 6081 CD patients screened, 97 had entero-urinary fistulas (frequency 1.6%). Seventy-five percent of fistulas occurred in men. After a median follow-up of 91 months, 96% of patients were in sustained remission. Thirty-three patients (35%) received anti-tumour necrosis factor (TNF) therapy. Of these, 45% achieved sustained remission (median follow-up 35 months) without needing surgery. More than 80% of patients required surgery, which induced remission (median follow-up 101 months) in 99% of them. Only the use of anti-TNF agents was associated with an increased rate of remission without need for surgery (hazard ratio 0.23, 95% confidence interval 0.12-0.44; p < 0.001). CONCLUSION: In this large cohort of CD patients, the frequency of entero-urinary fistulas was lower than previously described. More than 80% of patients required surgery, and in all but one of them surgery induced sustained remission. In a selected subgroup of patients, anti-TNF may induce long-term fistula remission and radiographic closure, making it possible to avoid surgery.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Crohn Disease/complications , Intestinal Fistula/drug therapy , Intestinal Fistula/surgery , Urinary Fistula/drug therapy , Urinary Fistula/surgery , Adalimumab/therapeutic use , Adolescent , Adult , Aged , Aged, 80 and over , Case-Control Studies , Combined Modality Therapy , Crohn Disease/therapy , Female , Follow-Up Studies , Humans , Infliximab/therapeutic use , Intestinal Fistula/etiology , Male , Mercaptopurine/therapeutic use , Middle Aged , Proportional Hazards Models , Remission Induction , Retrospective Studies , Treatment Outcome , Ureteral Diseases/drug therapy , Ureteral Diseases/etiology , Ureteral Diseases/surgery , Urinary Bladder Diseases/drug therapy , Urinary Bladder Diseases/etiology , Urinary Bladder Diseases/surgery , Urinary Fistula/etiology , Young Adult
3.
Biomaterials ; 72: 104-11, 2015 Dec.
Article in English | MEDLINE | ID: mdl-26352517

ABSTRACT

Urinary fistulas, abnormal openings of a urinary tract organ, are serious complications and conventional management strategies are not satisfactory. For more effective and non-invasive fistula repair, fluid tissue adhesives or sealants have been suggested. However, conventional products do not provide a suitable solution due to safety problems and poor underwater adhesion under physiological conditions. Herein, we proposed a unique water-immiscible mussel protein-based bioadhesive (WIMBA) exhibiting strong underwater adhesion which was employed by two adhesion strategies of marine organisms; 3,4-dihydroxy-l-phenylalanine (DOPA)-mediated strong adhesion and water-immiscible coacervation. The developed biocompatible WIMBA successfully sealed ex vivo urinary fistulas and provided good durability and high compliance. Thus, WIMBA could be used as a promising sealant for urinary fistula management with further expansion to diverse internal body applications.


Subject(s)
Proteins/therapeutic use , Urinary Fistula/drug therapy , Water/chemistry , Animals , Bivalvia , Dihydroxyphenylalanine/pharmacology , Male , Pressure , Proteins/pharmacology , Rats, Sprague-Dawley , Recombinant Proteins/pharmacology , Recombinant Proteins/therapeutic use , Tissue Adhesions/pathology
4.
BMJ Case Rep ; 20132013 Mar 15.
Article in English | MEDLINE | ID: mdl-23505283

ABSTRACT

A 25-year-old male patient underwent restorative proctocolectomy and ileoanal anastomosis in 1991 for refractory ulcerative colitis. In February 2001, he presented with pneumaturia, faecaluria, pelvic 'pressure' and watery diarrhoea caused by passage of urine through the anal canal. A fistula between the pouch and the membranous urethra was demonstrated by a pouchogram contrast study. In October 2002, he was started on ciprofloxacin 250 mg once daily and metronidazole 400 mg twice daily. Apart from a short break in 2003 the patient has remained on this regimen until the time of writing (now over 10 years) and has had sustained remission, excellent quality of life and no adverse effects.


Subject(s)
Anal Canal/surgery , Anti-Infective Agents/therapeutic use , Ciprofloxacin/therapeutic use , Colitis, Ulcerative/surgery , Colonic Pouches/adverse effects , Fistula/drug therapy , Fistula/etiology , Ileum/surgery , Metronidazole/therapeutic use , Urethral Diseases/drug therapy , Urethral Diseases/etiology , Urinary Fistula/drug therapy , Urinary Fistula/etiology , Adult , Anastomosis, Surgical/adverse effects , Humans , Male , Remission Induction , Time Factors
6.
Urol J ; 6(2): 120-2, 2009.
Article in English | MEDLINE | ID: mdl-19472131

ABSTRACT

INTRODUCTION: Persistent urine leakage is common following iatrogenic urinary collecting system injuries. Management of a urine leak usually includes manipulations such as catheter drainage, ureteral stenting, and percutaneous nephrostomy placement. The aim of this study was investigation the potential beneficial effect of desmopressin in reduction of urinary leakage duration. MATERIALS AND METHODS: Fifteen patients with incisional urinary leakage were enrolled in this study. They had undergone pyeloplasty (n = 9), pyelolithotomy (n = 4), and ureterocaliceal anastomosis (n = 1). All of them had ureteral stenting or nephrostomy catheters, and urinary leakage had lasted for at least 15 days. Seven patients received desmopressin spray, 1 puff, twice a day, from the 16th days of urinary leakage, and 8 patients (control group) did not receive any medical treatment. The duration of urinary leakage was compared between the two groups. RESULTS: The patients were 5 women and 10 men with the median age of 37 years (range, 26 to 58 years). None of the patients had urinary obstruction. There were no significant differences in age and sex distribution between the two groups. The mean urinary leakage duration was 28.7 +/- 7.2 days in the patients of desmopressin group and 47.7 +/- 8.8 days in those of the control group (P = .04). CONCLUSION: Our study showed that desmopressin can reduce the duration of incisional urinary leakage. We conclude that patients with prolonged urinary leakage after pyelocaliceal surgery who does not respond to surgical urinary drainage may benefit from desmopressin.


Subject(s)
Deamino Arginine Vasopressin/therapeutic use , Hemostatics/therapeutic use , Nephrostomy, Percutaneous/adverse effects , Postoperative Complications/drug therapy , Urinary Fistula/drug therapy , Adult , Anastomosis, Surgical/adverse effects , Case-Control Studies , Female , Follow-Up Studies , Humans , Kidney Calculi/surgery , Male , Middle Aged , Nephrostomy, Percutaneous/methods , Prospective Studies , Risk Assessment , Treatment Outcome , Ureteral Calculi/surgery , Urinary Catheterization/adverse effects , Urinary Fistula/etiology
7.
Am J Gastroenterol ; 99(3): 445-9, 2004 Mar.
Article in English | MEDLINE | ID: mdl-15056083

ABSTRACT

OBJECTIVES: Infliximab has been shown to be efficacious for treating perianal fistulae in patients with Crohn's disease. There is limited information regarding response to infliximab in patients with other types of fistulae. METHODS: Sixty consecutive patients with fistulous Crohn's disease and at least three months of follow-up after three infliximab infusions were evaluated. Patients with enteroenteric fistulae were excluded. Complete response was defined as complete closure of the fistulae or complete cessation of fistula drainage. RESULTS: Thirty-five patients had external fistulae, 16 had internal fistulae, and 9 had mixed (both external and internal) fistulae. Complete response rates were significantly higher in patients with external fistulae (69%) compared to those with internal fistulae (13%); p= 0.001, or those with mixed fistulae (11%); p= 0.01. In the external fistula group, patients with perianal fistulae had a higher rate of complete response (78%) compared to those with abdominal wall fistulae (38%); p= 0.04. The rate of complete response to infliximab was significantly lower among 14 patients with rectovaginal fistulae (14%) compared to those with perianal fistulae (78%); p= 0.0007. In the mixed fistula group only 11% of the patients achieved complete response. This is significantly lower than the rate observed for patients with perianal fistulae (78%); p= 0.004. The Cox proportional hazards model showed that the hazard of relapse for smokers who achieved complete response was nearly twice that of nonsmokers; however, this difference did not reach statistical significance. CONCLUSION: There is an association between type of fistulae and complete response to infliximab in patients with fistulous Crohn's disease. External fistulae in general and perianal fistulae in particular have a higher rate of closure in response to infliximab compared to other types of fistulae.


Subject(s)
Antibodies, Monoclonal/therapeutic use , Crohn Disease/complications , Cutaneous Fistula/drug therapy , Cutaneous Fistula/etiology , Gastrointestinal Agents/therapeutic use , Intestinal Fistula/drug therapy , Intestinal Fistula/etiology , Urinary Fistula/drug therapy , Urinary Fistula/etiology , Adolescent , Adult , Cohort Studies , Female , Follow-Up Studies , Humans , Infliximab , Male , Middle Aged
8.
Aliment Pharmacol Ther ; 18(10): 1003-8, 2003 Nov 15.
Article in English | MEDLINE | ID: mdl-14616166

ABSTRACT

BACKGROUND: Controlled trials have demonstrated the efficacy of methotrexate in the induction and maintenance of remission in luminal Crohn's disease; however, its effect on fistulizing disease is unknown. AIM: To describe the response to methotrexate therapy in a series of patients with fistulizing Crohn's disease. METHODS: A retrospective chart review was conducted of all patients with Crohn's disease receiving methotrexate in one practice. The response of patients with fistulizing and luminal disease was assessed using clinical and laboratory criteria. Fistula response was categorized as either complete or partial closure. RESULTS: Thirty-seven courses of methotrexate therapy were given to 33 patients with luminal and/or fistulizing Crohn's disease. In 16 patients with fistulas, four (25%) had complete closure, five (31%) had partial closure and all had failed or were intolerant to 6-mercaptopurine therapy. Overall, response to methotrexate was seen in 23 of 37 (62%) treatment courses in patients with luminal and/or fistulizing Crohn's disease. Two of the 33 patients (6%) had a significant adverse event. CONCLUSIONS: In this case series, 56% of patients with Crohn's fistulas on methotrexate showed a complete or partial response to therapy. Further studies are needed to confirm the role of methotrexate alone, and in combination with other therapies, for the treatment of fistulizing Crohn's disease.


Subject(s)
Crohn Disease/drug therapy , Gastrointestinal Agents/therapeutic use , Intestinal Fistula/drug therapy , Abdominal Wall , Administration, Oral , Adolescent , Adult , Aged , Crohn Disease/complications , Cutaneous Fistula/complications , Cutaneous Fistula/drug therapy , Cyclosporine/therapeutic use , Female , Humans , Injections, Intramuscular , Intestinal Fistula/complications , Male , Mercaptopurine/therapeutic use , Middle Aged , Rectal Diseases/complications , Rectal Diseases/drug therapy , Retrospective Studies , Treatment Outcome , Urinary Bladder Diseases/complications , Urinary Bladder Diseases/drug therapy , Urinary Fistula/complications , Urinary Fistula/drug therapy , Vaginal Fistula/complications , Vaginal Fistula/drug therapy
12.
Int J Colorectal Dis ; 10(4): 183-8, 1995.
Article in English | MEDLINE | ID: mdl-8568400

ABSTRACT

We report the thirteenth case of a recto-urethral fistula in Crohn's disease. The patient, a 37-year-old white male, had a 20-year history of intestinal Crohn's disease and had undergone numerous bowel resections. His symptoms were fecaluria, urorrhea and passing of urine from an orifice just outside the base of the scrotum. He had urinary infection and severe ileocolitis. He underwent a diagnostic evaluation (cystourethroscopy, proctoscopy, retrograde pyelography, intravenous urography, voiding cystourethrography) that revealed a fistula comprising the membranous urethra, the rectum, the perineum and the scrotum. He was treated with Metronidazole (20 mg/kg/day/12 mo). At 1 year no signs of intestinal disease and urinary sepsis were noted. The external orifice and the perineal fistulous network were closed, and the drainage from the rectum and the urethra had improved. No side effects limited use of the drug. No relapse was observed in the 3 months, after the therapy was discontinued. We present a review of the literature on the management of rectourethral fistulas in Crohn's disease. Surgeons have used successfully several approaches in the repair of this lesion, but no single procedure has proved optimal or even universally applicable. We emphasize, as the literature suggests, that the management must be individualized. Medical therapy with metronidazole has an important role in a patient with rectourethral fistula and concomitant proctitis, ileocolitis, urinary sepsis and multiple previous surgical procedures.


Subject(s)
Crohn Disease/complications , Rectal Fistula/drug therapy , Urethral Diseases/drug therapy , Urinary Fistula/drug therapy , Adult , Follow-Up Studies , Humans , Male , Metronidazole/administration & dosage , Perineum , Rectal Fistula/diagnosis , Scrotum , Urethral Diseases/diagnosis , Urinary Fistula/diagnosis
13.
Acta Urol Belg ; 60(3): 27-33, 1992.
Article in French | MEDLINE | ID: mdl-1492632

ABSTRACT

Ureteric and bladder vaginal fistulas are recognized complications of gynaecologic surgery. We report on 4 cases of fistulas (2 uretero-vaginal and 2 vesico-vaginal) successfully treated by urinary drainage associated with plugging of fistula with fibrin sealant. Efficiency of conservative treatments is directly related to early application. Mechanical and biological properties of fibrin sealant explain its possible role in recovery, without increasing risk of viral transmission.


Subject(s)
Fibrin Tissue Adhesive/therapeutic use , Ureteral Diseases/etiology , Urinary Fistula/etiology , Vaginal Fistula/etiology , Adult , Aged , Female , Humans , Hysterectomy , Middle Aged , Postoperative Complications/etiology , Urinary Bladder Fistula/drug therapy , Urinary Bladder Fistula/etiology , Urinary Fistula/drug therapy , Vaginal Fistula/drug therapy
14.
Br J Vener Dis ; 53(3): 200-2, 1977 Jun.
Article in English | MEDLINE | ID: mdl-871898

ABSTRACT

A case of Buschke-Löwenstein's tumour presenting with urinary fistula is described. The large lesion in the subpreputial sac occluded the preputial opening and infiltrated beneath the skin of the shaft of the penis resulting in a fungating growth encasing the fistulous tract. The lesion responded well to 25% podophyllin, which is reportedly unusual.


Subject(s)
Condylomata Acuminata/complications , Penile Neoplasms/complications , Urinary Fistula/etiology , Adult , Condylomata Acuminata/drug therapy , Humans , Male , Penile Neoplasms/drug therapy , Podophyllin/therapeutic use , Syndrome , Urinary Fistula/drug therapy
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