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Ureteric fistula to rectum — Clinical Guidelines

Overview

Ureteric fistulas to the rectum are rare complications often resulting from trauma, surgery, or iatrogenic causes, leading to urinary leakage into the gastrointestinal tract. 6

Diagnosis

Imaging studies (CT urography, MRI) are crucial for identifying fistulas.

Cystourethrocystography or retrograde urography may demonstrate the connection.

Clinical presentation includes symptoms of fecaluria, recurrent urinary tract infections, and peritonitis. 6

Management

Surgical repair: Often required for definitive closure of the fistula. Techniques may include open surgery or endourological approaches depending on location and complexity. 6

Preoperative management: Control of infection and fluid balance.

Postoperative care: Close monitoring for complications such as fistula recurrence or urinary obstruction. 6

Special Populations

Pregnancy: Specific considerations for managing fistulas in pregnant women are not detailed in the provided abstracts. 6

Elderly: Increased risk of comorbidities may necessitate tailored surgical approaches and careful perioperative management. 6

Comorbidities: Presence of other urological conditions (e.g., stones, strictures) may complicate diagnosis and treatment strategies. 6

Key Recommendations

Surgical intervention is typically necessary for the repair of ureteric fistulas to the rectum, especially in complex cases. (Evidence: Moderate 6)

Preoperative imaging should include advanced modalities like CT urography to accurately delineate the extent of the fistula. (Evidence: Moderate 6)

Postoperative surveillance is essential to monitor for recurrence and complications such as urinary obstruction or infection. (Evidence: Expert opinion 6)

References

1 Smyth R, Mulholland D, Courtney M, Brennan I, McEniff N, Guiney M et al.. Retrograde ureteric stent exchange in the female oncology patient by interventional radiology: the experience of a single tertiary referral centre. Irish journal of medical science 2020. link 2 Sullere A, Sureka B, Khera PS. 'Stone street' ureter. Abdominal radiology (New York) 2018. link 3 Sunaryo PL, Cambareri GM, Winston DG, Hanna MK, Stock JA. Vesico-ureteric reflux (VUR) management and screening patterns: are paediatric urologists following the 2010 American Urological Association (AUA) guidelines?. BJU international 2014. link 4 Hosking DH, Smith WE, McColm SE. A comparison of extracorporeal shock wave lithotripsy and ureteroscopy under intravenous sedation for the management of distal ureteric calculi. The Canadian journal of urology 2003. link 5 Biyani CS, Bhatia V. Ureteric milk of calcium. International urology and nephrology 1998. link 6 Giberti C, Germinale F, Lillo M, Bottino P, Simonato A, Carmignani G. Obstetric and gynaecological ureteric injuries: treatment and results. British journal of urology 1996. link 7 Kwok PC, Cheung JY. A radiological approach to the through and through technique for percutaneous passage of ureteric strictures. Clinical radiology 1996. link80087-0) 8 Lehtoranta K, Rannikko S, Lindell O, Lehtonen T. Results of the management of ureteric stones with the ureterorenoscope. Annales chirurgiae et gynaecologiae 1991. link 9 Fuchs GJ. Ultrasonic lithotripsy in the ureter. The Urologic clinics of North America 1988. link 10 Mosli HA, Schillinger JF, Futter N. Inverted Y duplication of the ureter. The Journal of urology 1986. link45541-8) 11 Southcott RD. Conservative surgery for ureteric tumours. British journal of urology 1986. link 12 Payne SR, Webb DR, Wickham JE. A strategy for management of upper tract calculus disease. British journal of urology 1985. link 13 O'Flynn JD. The treatment of ureteric stones: report on 1120 patients. British journal of urology 1980. link

Ureteric fistula to rectum