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Spontaneous Ureterocutaneous Fistula Secondary to Obstructed Ureteric Stone
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Spontaneous ureterocutaneous fistula secondary to obstructed ureteric stone Subhabrata Mukherjee M.Ch (Urology), MRCS , Rajan Kumar Sinha M.Ch (Urology) , Soumendra Nath Mandal M.Ch (Urology) , Wei Shen Tan MRCS, PhD PII: DOI: Reference:
S0090-4295(20)30064-9 https://doi.org/10.1016/j.urology.2020.01.013 URL 21944
To appear in:
Urology
Received date: Revised date: Accepted date:
22 November 2019 30 December 2019 6 January 2020
Please cite this article as: Subhabrata Mukherjee M.Ch (Urology), MRCS , Rajan Kumar Sinha M.Ch (Urology) , Soumendra Nath Mandal M.Ch (Urology) , Wei Shen Tan MRCS, PhD , Spontaneous ureterocutaneous fistula secondary to obstructed ureteric stone, Urology (2020), doi: https://doi.org/10.1016/j.urology.2020.01.013
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2020 Published by Elsevier Inc.
Images in Clinical Urology
Spontaneous ureterocutaneous fistula secondary to obstructed ureteric stone Subhabrata Mukherjee, M.Ch (Urology), MRCS1,2 Rajan Kumar Sinha, M.Ch (Urology)2,3 Soumendra Nath Mandal, M.Ch (Urology)2 Wei Shen Tan, MRCS, PhD1,4*
1. Department of Urology, London North West University Healthcare NHS Trust, London, UK. 2. Department of Urology, Calcutta National Medical College and Hospital, Kolkata, West Bengal, India. 3. Department of Urology, Kidney Stone and Urology Clinic, Jail Road, Bhagalpur, Bihar, India. 4. Division of Surgery & Interventional Science, University College London, London, UK
*Corresponding author Wei Shen Tan, MRCS, PhD Division of Surgery & Interventional Science, Charles Bell House, 43-45 Foley St, Fitzrovia, London W1W 7TY. Email: [email protected]
Abstract: 42 words Manuscript: 198 words Figures: 3 Keywords: renal stone; ureterocutaneous fistula; renal calculi Acknowledgements: We thank the patient for allowing us to use her images as part of this manuscript.
Abstract We present a unique case of ureterocutaneous fistula secondary to an obstructed ureteric stone. A fistulagram confirmed a communication between right flank and the proximal ureter. Ureterocutanoues fistula in the absence of trauma, iatrogenic causes, granulomatous infection or malignancy is highly unusual.
Manuscript A 25 years female presented with a three-month history of fever, swelling and purulent discharge from her right flank. An intravenous urogram (IVU) confirmed a large right ureteric stone in the mid-ureter with a non-excreting right kidney. A fistulogram suggested a communication of the fistula tract with proximal right ureter. A diethylenetriamine pentaacetic acid (DTPA) renal scan showed non-functioning right kidney with normal contralateral kidney. Culture of the discharge material grew Klebsiella and was negative for acid fast bacilli. The patient underwent right sided open nephroureterectomy with excision of the fistula tract. Post-operative period was uneventful. Histopathological examination of the fistula tract showed fibrocollagenous tissue without any evidence of granulomatous infection or malignancy. Ureterocutaneous fistula (UCF) is defined as an abnormal communication between the ureter and skin. UCF generally arises secondary to surgery, trauma, malignancy or granulomatous infection.1, 2 Patient typically presents with purulent discharge through an abnormal skin opening with or without pain and fever. 3,4 An IVU or preferably computed tomography urogram with delayed phase and fistulogram are usually essential for diagnosis. Management of UCF typically involves surgical excision although ureteric reconstruction over an antegrade stent has been reported when preservation of the kidney affected is required.5
References: 1. Otunctemur A, Sahin S, Dursun M, et al. Ureterocutaneous fistula caused by vesicoureteral reflux after nephrectomy. Minerva urologica e nefrologica = The Italian journal of urology and nephrology. 2014;66:151-152. 2. Warnock N, O'Flynn KJ, Thomas DG. Xanthogranulomatous pyelonephritis and ureterocutaneous fistula. British journal of urology. 1991;67:549-550. 3. Shahidi S, Fries J, Kay L. A ureterocutaneous fistula forty years after nephrectomy. Scandinavian journal of urology and nephrology. 2000;34:282-283. 4. Mahmood K, Singh M, Pankaj S et al. Ureterocutaneous fistula with persisting stone in ureteral stump long time after nephrectomy. Journal of Evolution of Medical and Dental Sciences. 2014;3:4663-5. 5. Lang EK. Diagnosis and management of ureteral fistulas by percutaneous nephrostomy and antegrade stent catheter. Radiology. 1981;138:311-317.
Figure legends:
Figure 1: A. Discharging fistula in right side of the back in a patient with kyphoscoliosis. Convexity of the lumber spine to the left sided is evident. B. Intravenous urogram 25 min following injection of intravenous contrast confirming a 1.5 cm radio-opaque calculi shadow in the line of right ureter at the junction of 4th and 5th lumbar vertebra with a non-excreting right kidney.
Figure 2: A. Control film of a fistulogram showing a large radio-opaque shadow in the line of right ureter at the junction of 4th and 5th lumbar vertebra. B. The fistulogram confirms contrast extravasation at the fistula site with downward flow of contrast up to the obstructing ureteric stone.
Figure 3: A. Right-sided subcostal extra-peritoneal approach exposing the right kidney and ureter. The tip of the dissecting forceps is pointing towards the ureteric stone. B. The ureteric stone is evident after uereterotomy. C. An artery forceps has been passed through the uretero-cutaneous fistula. D. Specimen of nephroureterectomy and the ureteric stone.
Spontaneous ureterocutaneous fistula secondary to obstructed ureteric stone Subhabrata Mukherjee M.Ch (Urology), MRCS , Rajan Kumar Sinha M.Ch (Urology) , Soumendra Nath Mandal M.Ch (Urology) , Wei Shen Tan MRCS, PhD PII: DOI: Reference:
S0090-4295(20)30064-9 https://doi.org/10.1016/j.urology.2020.01.013 URL 21944
To appear in:
Urology
Received date: Revised date: Accepted date:
22 November 2019 30 December 2019 6 January 2020
Please cite this article as: Subhabrata Mukherjee M.Ch (Urology), MRCS , Rajan Kumar Sinha M.Ch (Urology) , Soumendra Nath Mandal M.Ch (Urology) , Wei Shen Tan MRCS, PhD , Spontaneous ureterocutaneous fistula secondary to obstructed ureteric stone, Urology (2020), doi: https://doi.org/10.1016/j.urology.2020.01.013
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2020 Published by Elsevier Inc.
Images in Clinical Urology
Spontaneous ureterocutaneous fistula secondary to obstructed ureteric stone Subhabrata Mukherjee, M.Ch (Urology), MRCS1,2 Rajan Kumar Sinha, M.Ch (Urology)2,3 Soumendra Nath Mandal, M.Ch (Urology)2 Wei Shen Tan, MRCS, PhD1,4*
1. Department of Urology, London North West University Healthcare NHS Trust, London, UK. 2. Department of Urology, Calcutta National Medical College and Hospital, Kolkata, West Bengal, India. 3. Department of Urology, Kidney Stone and Urology Clinic, Jail Road, Bhagalpur, Bihar, India. 4. Division of Surgery & Interventional Science, University College London, London, UK
*Corresponding author Wei Shen Tan, MRCS, PhD Division of Surgery & Interventional Science, Charles Bell House, 43-45 Foley St, Fitzrovia, London W1W 7TY. Email: [email protected]
Abstract: 42 words Manuscript: 198 words Figures: 3 Keywords: renal stone; ureterocutaneous fistula; renal calculi Acknowledgements: We thank the patient for allowing us to use her images as part of this manuscript.
Abstract We present a unique case of ureterocutaneous fistula secondary to an obstructed ureteric stone. A fistulagram confirmed a communication between right flank and the proximal ureter. Ureterocutanoues fistula in the absence of trauma, iatrogenic causes, granulomatous infection or malignancy is highly unusual.
Manuscript A 25 years female presented with a three-month history of fever, swelling and purulent discharge from her right flank. An intravenous urogram (IVU) confirmed a large right ureteric stone in the mid-ureter with a non-excreting right kidney. A fistulogram suggested a communication of the fistula tract with proximal right ureter. A diethylenetriamine pentaacetic acid (DTPA) renal scan showed non-functioning right kidney with normal contralateral kidney. Culture of the discharge material grew Klebsiella and was negative for acid fast bacilli. The patient underwent right sided open nephroureterectomy with excision of the fistula tract. Post-operative period was uneventful. Histopathological examination of the fistula tract showed fibrocollagenous tissue without any evidence of granulomatous infection or malignancy. Ureterocutaneous fistula (UCF) is defined as an abnormal communication between the ureter and skin. UCF generally arises secondary to surgery, trauma, malignancy or granulomatous infection.1, 2 Patient typically presents with purulent discharge through an abnormal skin opening with or without pain and fever. 3,4 An IVU or preferably computed tomography urogram with delayed phase and fistulogram are usually essential for diagnosis. Management of UCF typically involves surgical excision although ureteric reconstruction over an antegrade stent has been reported when preservation of the kidney affected is required.5
References: 1. Otunctemur A, Sahin S, Dursun M, et al. Ureterocutaneous fistula caused by vesicoureteral reflux after nephrectomy. Minerva urologica e nefrologica = The Italian journal of urology and nephrology. 2014;66:151-152. 2. Warnock N, O'Flynn KJ, Thomas DG. Xanthogranulomatous pyelonephritis and ureterocutaneous fistula. British journal of urology. 1991;67:549-550. 3. Shahidi S, Fries J, Kay L. A ureterocutaneous fistula forty years after nephrectomy. Scandinavian journal of urology and nephrology. 2000;34:282-283. 4. Mahmood K, Singh M, Pankaj S et al. Ureterocutaneous fistula with persisting stone in ureteral stump long time after nephrectomy. Journal of Evolution of Medical and Dental Sciences. 2014;3:4663-5. 5. Lang EK. Diagnosis and management of ureteral fistulas by percutaneous nephrostomy and antegrade stent catheter. Radiology. 1981;138:311-317.
Figure legends:
Figure 1: A. Discharging fistula in right side of the back in a patient with kyphoscoliosis. Convexity of the lumber spine to the left sided is evident. B. Intravenous urogram 25 min following injection of intravenous contrast confirming a 1.5 cm radio-opaque calculi shadow in the line of right ureter at the junction of 4th and 5th lumbar vertebra with a non-excreting right kidney.
Figure 2: A. Control film of a fistulogram showing a large radio-opaque shadow in the line of right ureter at the junction of 4th and 5th lumbar vertebra. B. The fistulogram confirms contrast extravasation at the fistula site with downward flow of contrast up to the obstructing ureteric stone.
Figure 3: A. Right-sided subcostal extra-peritoneal approach exposing the right kidney and ureter. The tip of the dissecting forceps is pointing towards the ureteric stone. B. The ureteric stone is evident after uereterotomy. C. An artery forceps has been passed through the uretero-cutaneous fistula. D. Specimen of nephroureterectomy and the ureteric stone.