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The posterior sagittal transrectal approach (York-Mason) for repair of recto-urinary fistulas secondary to lower urinary tract surgery: our experience
P28
umoGIcALslJRGuFI
485
Maday, Febtwy 25,15.30-17.00 hr!s,RoomF TREATMENT DENERVATION
OF CHRONIC ORCHIALGIA OF THE SPERMATIC CORD
BY
SURGICAL
Lazarov Risto., Lock Tycho, Bevers Rob, Boon Tom
OUTCOME OF RENAL DENERVATION LOIN PAIN HAEMATURIA SYNDROME
FOR THE TREATMENT
OF
Greenwell Tamsin, Peters John, Shah Julian
Department of Urology, University Medical Center Utrecht, The Netherlands INTRODUCTION
& OBJECTIVE: Chronic orchialgia
to manage and in many patients patients are treated conservatively
(CO) is a difficult problem the etiology is of unknown origin. Most of the (antibiotics, analgesics, pain clinic) or, if this fails,
surgically (epididymectomy, orchiectomy). We describe the results of surgical denervation of the spermatic cord as an organ preserving alternative that can provide permanent pain relief for patients with CO. PATIENTS & METHODS: Since 1991, 9 patients with chronic orchialgia underwent denervation (4 microsurgical, 5 non-microsurgical) after conservative management failed (9 antibiotics, 8 analgesics, 2 antidepressants, I epididymectomy and I hydrocelectomy). All patients had a history of epididymitis (9) or prostatitis (4). and 7 patients had undergone prior scrotal surgery. Mean duration of pain was 18 months. Preoperative 4 patients underwent spermatic cord block with local anaesthetic resulting in temporary pain relief. Telephonic questionnaire was used to assess long-term pain relief. RESULTS: Follow-up ranged from 3 to 96 months (mean 43.7). Complete pain relief was achieved in 6, partial relief in I and no relief in 2 (table). In I patient who underwent a nonmicrosurgical denervation atrophied the testis secondary of ischemia. All the patients, excluding the last case. with pain relief will recommend this procedure to the their best friend; 4 of these patients had undergone microsurgical denervation. The 2 patients with no pain relief did not underwent spermatic cord block. Table: Pain relief after surgical
denervation
(n=9)
Denervation microsurgical non-microsurgical Pain relief Complete Partial
1
4
1None
2 1 2
CONCLUSION: Patients with chronic orchialgia refractory to conservative management can become permanent free of pain by surgical denervation of the spermatic cord. Microsurgical denervation is probably the better option. It is highly recommended to perform an initial cord block which can be used as a prognostic indicator
of surgical
success.
Urology, Institute of Urology and Nephrology,
London, United Kingdom
INTRODUCTION & OBJECTIVES: Loin pain haematuria syndrome (LPHS) is a rare but troublesome disorder of unknown aetiology associated with debilitating loin pain. A multitude of surgical interventions has been performed in LPHS in an attempt to alleviate pain. We have evaluated the outcome of renal denervation for the treatment of this condition in a tertiary referral centre. MATERIALS & METHODS: The case notes of 26 patients (15 female) having 30 renal denervations (4 bilateral) were reviewed. Data collected included patient demographics, possible aetiology, cure or not following renal denervation, time to recurrence of pain following denervation and further operative intervention for the management of LPHS associated pain. The median age of LPHS patients was 43 years (range 28-74) and the median follow-up period available was 36 months (range 6-104). RESULTS: The majority of patients had no identifiable aetiology for their LPHS although many had initially been diagnosed as suffering from pyelonephritis without any corroborative microbiology. Other putative predisposing factors ascribed to this patient group included stone disease, epididymo-orchitis and ureteric injury. All patients had been extensively investigated and had normal urine bacteriology, urine cytology, IVU, renal tract ultrasound scan and isotope renogram. Twenty-four patients (80%) had recurrent pain following denervation - recurring at a median of 1 month (iO.9) postsurgery. Six patients (20%) were cured or greatly improved by denervation. Of those with recurrent pain, II (46%) went on to have nephrectomy of the denervated side for pain management, of whom 5 (55%) then developed LPHS on the contralateral side. There were no significant postoperative complications. CONCLUSION: Renal denervation has only a 20% success rate for the management of pain associated with LPHS and should be performed with great caution for this indication.
487 THE POSTERIOR SAGITTAL MASON) FOR REPAIR SECONDARY TO LOWER EXPERIENCE Dal Bianco Massimo, Pagan0 Francesco
TRANSRECTAL APPROACH (YORKOF RECTO-URINARY FISTULAS URINARY TRACT SURGERY: OUR
Pinto Francesco,
Zanovello
Nicola, Dal Moro Fabrizio.
Urology, University of Padova, Padova, Italy INTRODUCTION & OBJECTIVES: Rectourinaty fistulas are rare, but a very difficult problem to solve when they occur. The great majority are secondary to lower urinary tract or rectal surgery, a minor part are secondary to lower urinary tract infections, radiotherapy or trauma. Many surgical approaches have been proposed for their repair. We report our experience with posterior sagittal transrectal approach according with York-Mason technique for repair of iatogenic recta-urinary fistulas.
WITHDRAWN
MATERIALS & METHODS: Since 1989 to November 2000, in our Institute, repair of rectourinary fistulas with the posterior York-Mason approach was performed in 6 patients. The fistulas developed after radical prostatectomy in 3 cases (2 patients were exposed to radiotherapy before surgery), after transvescical adenomectomy in 1 case, after transurethral prostate resection (TURP) in another case and after radical cistectomy and ileal ortotopic neobladder in the last case. In all patients colonstomy was performed before repair. RESULTS: 5 of the 6 fistulas were repaired successfully (83.3%), while in I patient with Chron disease the fistula recidived after I I years from surgical procedure. One patient died after I year from surgical procedure for metastatic prostatic carcinoma. In 4 Patients colonstomy has been closed with perfect faecal continence and without postoperative anal strictures. Colonstomy has not yet closed for Crohn disease in one case and ulcerative rectocolitis in the other one. Only 2 postoperative complications were noticed: I small diastasis of the cutaneous wound closed with hyperbaric therapy and in another case a small recta-cutaneous fistula closed spontaneously. CONCLUSION: The sagittal posterior transanal approach described from York-Mason in patients with iatrogenic recta-urinary tistulae offers excellent exposure of the tistula site, optimal position for excision of the fistulous tract crossing through healthy not operated tissues with no risk of strictures or loss of fecal continence. We believe that the York-Mason approach is a highly effective and minimally morbid procedure for repair of iatrogenic recta-urinary fistula.
European
Urology Supplements 1 (2002) No. 1, pp. 124
umoGIcALslJRGuFI
485
Maday, Febtwy 25,15.30-17.00 hr!s,RoomF TREATMENT DENERVATION
OF CHRONIC ORCHIALGIA OF THE SPERMATIC CORD
BY
SURGICAL
Lazarov Risto., Lock Tycho, Bevers Rob, Boon Tom
OUTCOME OF RENAL DENERVATION LOIN PAIN HAEMATURIA SYNDROME
FOR THE TREATMENT
OF
Greenwell Tamsin, Peters John, Shah Julian
Department of Urology, University Medical Center Utrecht, The Netherlands INTRODUCTION
& OBJECTIVE: Chronic orchialgia
to manage and in many patients patients are treated conservatively
(CO) is a difficult problem the etiology is of unknown origin. Most of the (antibiotics, analgesics, pain clinic) or, if this fails,
surgically (epididymectomy, orchiectomy). We describe the results of surgical denervation of the spermatic cord as an organ preserving alternative that can provide permanent pain relief for patients with CO. PATIENTS & METHODS: Since 1991, 9 patients with chronic orchialgia underwent denervation (4 microsurgical, 5 non-microsurgical) after conservative management failed (9 antibiotics, 8 analgesics, 2 antidepressants, I epididymectomy and I hydrocelectomy). All patients had a history of epididymitis (9) or prostatitis (4). and 7 patients had undergone prior scrotal surgery. Mean duration of pain was 18 months. Preoperative 4 patients underwent spermatic cord block with local anaesthetic resulting in temporary pain relief. Telephonic questionnaire was used to assess long-term pain relief. RESULTS: Follow-up ranged from 3 to 96 months (mean 43.7). Complete pain relief was achieved in 6, partial relief in I and no relief in 2 (table). In I patient who underwent a nonmicrosurgical denervation atrophied the testis secondary of ischemia. All the patients, excluding the last case. with pain relief will recommend this procedure to the their best friend; 4 of these patients had undergone microsurgical denervation. The 2 patients with no pain relief did not underwent spermatic cord block. Table: Pain relief after surgical
denervation
(n=9)
Denervation microsurgical non-microsurgical Pain relief Complete Partial
1
4
1None
2 1 2
CONCLUSION: Patients with chronic orchialgia refractory to conservative management can become permanent free of pain by surgical denervation of the spermatic cord. Microsurgical denervation is probably the better option. It is highly recommended to perform an initial cord block which can be used as a prognostic indicator
of surgical
success.
Urology, Institute of Urology and Nephrology,
London, United Kingdom
INTRODUCTION & OBJECTIVES: Loin pain haematuria syndrome (LPHS) is a rare but troublesome disorder of unknown aetiology associated with debilitating loin pain. A multitude of surgical interventions has been performed in LPHS in an attempt to alleviate pain. We have evaluated the outcome of renal denervation for the treatment of this condition in a tertiary referral centre. MATERIALS & METHODS: The case notes of 26 patients (15 female) having 30 renal denervations (4 bilateral) were reviewed. Data collected included patient demographics, possible aetiology, cure or not following renal denervation, time to recurrence of pain following denervation and further operative intervention for the management of LPHS associated pain. The median age of LPHS patients was 43 years (range 28-74) and the median follow-up period available was 36 months (range 6-104). RESULTS: The majority of patients had no identifiable aetiology for their LPHS although many had initially been diagnosed as suffering from pyelonephritis without any corroborative microbiology. Other putative predisposing factors ascribed to this patient group included stone disease, epididymo-orchitis and ureteric injury. All patients had been extensively investigated and had normal urine bacteriology, urine cytology, IVU, renal tract ultrasound scan and isotope renogram. Twenty-four patients (80%) had recurrent pain following denervation - recurring at a median of 1 month (iO.9) postsurgery. Six patients (20%) were cured or greatly improved by denervation. Of those with recurrent pain, II (46%) went on to have nephrectomy of the denervated side for pain management, of whom 5 (55%) then developed LPHS on the contralateral side. There were no significant postoperative complications. CONCLUSION: Renal denervation has only a 20% success rate for the management of pain associated with LPHS and should be performed with great caution for this indication.
487 THE POSTERIOR SAGITTAL MASON) FOR REPAIR SECONDARY TO LOWER EXPERIENCE Dal Bianco Massimo, Pagan0 Francesco
TRANSRECTAL APPROACH (YORKOF RECTO-URINARY FISTULAS URINARY TRACT SURGERY: OUR
Pinto Francesco,
Zanovello
Nicola, Dal Moro Fabrizio.
Urology, University of Padova, Padova, Italy INTRODUCTION & OBJECTIVES: Rectourinaty fistulas are rare, but a very difficult problem to solve when they occur. The great majority are secondary to lower urinary tract or rectal surgery, a minor part are secondary to lower urinary tract infections, radiotherapy or trauma. Many surgical approaches have been proposed for their repair. We report our experience with posterior sagittal transrectal approach according with York-Mason technique for repair of iatogenic recta-urinary fistulas.
WITHDRAWN
MATERIALS & METHODS: Since 1989 to November 2000, in our Institute, repair of rectourinary fistulas with the posterior York-Mason approach was performed in 6 patients. The fistulas developed after radical prostatectomy in 3 cases (2 patients were exposed to radiotherapy before surgery), after transvescical adenomectomy in 1 case, after transurethral prostate resection (TURP) in another case and after radical cistectomy and ileal ortotopic neobladder in the last case. In all patients colonstomy was performed before repair. RESULTS: 5 of the 6 fistulas were repaired successfully (83.3%), while in I patient with Chron disease the fistula recidived after I I years from surgical procedure. One patient died after I year from surgical procedure for metastatic prostatic carcinoma. In 4 Patients colonstomy has been closed with perfect faecal continence and without postoperative anal strictures. Colonstomy has not yet closed for Crohn disease in one case and ulcerative rectocolitis in the other one. Only 2 postoperative complications were noticed: I small diastasis of the cutaneous wound closed with hyperbaric therapy and in another case a small recta-cutaneous fistula closed spontaneously. CONCLUSION: The sagittal posterior transanal approach described from York-Mason in patients with iatrogenic recta-urinary tistulae offers excellent exposure of the tistula site, optimal position for excision of the fistulous tract crossing through healthy not operated tissues with no risk of strictures or loss of fecal continence. We believe that the York-Mason approach is a highly effective and minimally morbid procedure for repair of iatrogenic recta-urinary fistula.
European
Urology Supplements 1 (2002) No. 1, pp. 124