Objective
To describe a single-center experience with the management of ileal pouch-urethral
fistulas (IPUF) following restorative proctocolectomy with ileal pouch-anal anastomosis
(IPAA).
Methods
We retrospectively identified patients with documented IPUF managed at our institution
from a urethral fistula cohort and analyzed their cases.
Results
Thirteen patients who underwent surgeries for IPUF management from 2005-2022 were
identified. Median age at IPAA was 29 years (range 11-53). Indications for IPAA included
familial adenomatous polyposis (n=3) and ulcerative colitis (n=10). Median time from
IPAA to fistula diagnosis was 15 years (range 0.5-38.5). Eleven patients were initially
diverted with either loop (n=8) or end ileostomy (n=3). Overall, two patients had
resolution of IPUF symptoms with a loop ileostomy alone and eight eventually underwent
pouch excision with end ileostomy, one of which subsequently underwent redo IPAA.
Seven patients were managed with primary closure of the urethral defect at the time
of pouch excision, five of which also underwent gracilis muscle interposition. With
a median follow-up of 4 years (range 0.3-13 years), all patients had resolution of
their fistulae without any recurrences.
Conclusion
IPUFs are a rare complication after IPAA. In this cohort, all patients had their urinary
tract preserved, but most ultimately had permanent fecal diversion. These results
can help guide management of this complex issue.
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Article info
Publication history
Published online: December 04, 2022
Accepted:
October 17,
2022
Received:
August 30,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Conflict of interest: João Pedro Emrich Accioly, Mariana Maspero, Hanson Zhao, Roger K. Khouri Jr., Olga Lavryk, Tracy Hull and Hadley M. Wood have no conflicts of interest relevant to this article to disclose.
Financial Disclosure: This study did not receive any grants of financial assistance.
Identification
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