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Fistula

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Handbook of Neurourology

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Abstract

Neurogenic patients are in need of frequent urine drainage using a urethral or suprapubic catheter to ensure proper drainage and guard against pain, stone formation, infection, autonomic dysreflexia, or renal dysfunction. This maneuver may lead to multiple urological complications such as urethral erosion, urinary fistula, urethral stricture, urethral injury, skin dermatitis, maceration, fungal and bacterial infections, or skin breakdown.

Urethral erosion from prolonged catheterization ranges from a partial-thickness wound involving a small area of the glans penis to a full-thickness pressure ulcer, or erosion, cleaving the glans or penile shaft. It causes cosmetic disfigurement and increases the risk of bleeding and urinary tract infections.

Urethrocutaneous fistula (UCF) is not a common complication in a neurogenic bladder. However, it is associated with considerable morbidity. It may develop due to neglected bedsores, infection, poor hygiene, and long-term urinary catheterization with or without trauma.

Spontaneous vesico-rectal fistula is a rare sequela to a neurogenic bladder that may develop due to a neglected infection associated with poor bladder and rectal emptying and distention.

Management will require urinary diversion, treatment of infections, and staged urethral reconstruction. The possible way to avoid catheter-related complications is to avoid using an indwelling urinary catheter and replace it with a continuous intermittent catheterization if feasible or to place a suprapubic catheter, proper hygiene, sterile application of a urethral catheter with maintaining a closed drainage system, and proper security of the catheter to the upper thigh on a woman and on the abdomen.

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  1. Ain Shams University Hospitals, Cairo, Egypt

    M. Sherif Mourad & Ahmed Maher Gamil Ahmed Higazy

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  1. M. Sherif Mourad
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  2. Ahmed Maher Gamil Ahmed Higazy
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Correspondence to M. Sherif Mourad .

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  1. Department of Urology, China Rehabiliation Research Center Capital Medical University, Beijing, China

    Limin Liao

  2. Department of Urology, University Hospital Innsbruck, Innsbruck, Austria

    Helmut Madersbacher

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Mourad, M.S., Higazy, A.M.G.A. (2022). Fistula. In: Liao, L., Madersbacher, H. (eds) Handbook of Neurourology. Springer, Singapore. https://doi.org/10.1007/978-981-16-7939-1_84-1

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