G Loske1, T Schorsch2, R U Kiesow3, C T Müller2. 1. Department of General, Abdominal, Thoracic and Vascular Surgery, Katholisches Marienkrankenhaus Hamburg gGmbH, Alfredstraße 9, 22087, Hamburg, Germany. loske.chir@marienkrankenhaus.org. 2. Department of General, Abdominal, Thoracic and Vascular Surgery, Katholisches Marienkrankenhaus Hamburg gGmbH, Alfredstraße 9, 22087, Hamburg, Germany. 3. Clinic for Urology, Katholisches Marienkrankenhaus Hamburg gGmbH, Hamburg, Germany.
Abstract
PURPOSE: The technique of active urinary endoscopic vacuum therapy (uEVT) is described. The surgical technique is demonstrated in detail with the help of a video of the operation, which is available online. Vesical fistulas are a rare complication following rectal surgery. The EVT technique is a novel method for the treatment of gastrointestinal leakage. This endoscopic procedure has been adapted to treat a large bladder defect after abdomino-perineal resection of the rectum with urine flowing out of the perineal wound. MATERIALS AND METHODS: A new open-pore film drainage (OFD) catheter with an external diameter of only a few millimeters was developed and constructed from a very thin open-pore double-layered film and a drainage tube. The OFD was inserted into the bladder by means of flexible endoscopy and channeled out through a suprapubic incision. Continuous suction was applied with an electronic vacuum pump to actively drain the urine completely. A passive catheter drainage of urine from the renal pelvis via a transurethral single J stent was carried out simultaneously during the complete duration of treatment. The healing process was monitored during and after therapy via intravesical endoscopy. RESULTS: The application of continuous negative pressure via the OFD resulted in total collapse of the bladder. The urine in the bladder was actively and permanently drained through the OFD. Urine leakage from the perineal wound stopped immediately after induction of suction. The bladder defect healed after 18 days of treatment with uEVT. After therapy and removal of the catheters, the patient had normal micturition. CONCLUSION: A novel small-bore OFD was developed for EVT. The OFD technique allows for endoscopic application of negative pressure in the bladder. This first successful experience proves uEVT to be a potent interventional alternative in the treatment of bladder defects.
PURPOSE: The technique of active urinary endoscopic vacuum therapy (uEVT) is described. The surgical technique is demonstrated in detail with the help of a video of the operation, which is available online. Vesical fistulas are a rare complication following rectal surgery. The EVT technique is a novel method for the treatment of gastrointestinal leakage. This endoscopic procedure has been adapted to treat a large bladder defect after abdomino-perineal resection of the rectum with urine flowing out of the perineal wound. MATERIALS AND METHODS: A new open-pore film drainage (OFD) catheter with an external diameter of only a few millimeters was developed and constructed from a very thin open-pore double-layered film and a drainage tube. The OFD was inserted into the bladder by means of flexible endoscopy and channeled out through a suprapubic incision. Continuous suction was applied with an electronic vacuum pump to actively drain the urine completely. A passive catheter drainage of urine from the renal pelvis via a transurethral single J stent was carried out simultaneously during the complete duration of treatment. The healing process was monitored during and after therapy via intravesical endoscopy. RESULTS: The application of continuous negative pressure via the OFD resulted in total collapse of the bladder. The urine in the bladder was actively and permanently drained through the OFD. Urine leakage from the perineal wound stopped immediately after induction of suction. The bladder defect healed after 18 days of treatment with uEVT. After therapy and removal of the catheters, the patient had normal micturition. CONCLUSION: A novel small-bore OFD was developed for EVT. The OFD technique allows for endoscopic application of negative pressure in the bladder. This first successful experience proves uEVT to be a potent interventional alternative in the treatment of bladder defects.
Entities:
Keywords:
Catheter; Drainage; Fistula; Gastroenterology; Video
Authors: Gunnar Loske; Tobias Schorsch; Vera van Ackeren; Wolfgang Schulze; Christian T Müller Journal: Endoscopy Date: 2015-08-14 Impact factor: 10.093
Authors: Jennifer M Hanna; Ryan Turley; Anthony Castleberry; Thomas Hopkins; Andrew C Peterson; Christopher Mantyh; John Migaly Journal: Dis Colon Rectum Date: 2014-09 Impact factor: 4.585
Authors: Jonathan Loeck; Hans-Jürgen von Lücken; Adrian Münscher; Christian Theodor Müller; Gunnar Loske Journal: Eur Arch Otorhinolaryngol Date: 2021-03-14 Impact factor: 2.503
Authors: Gunnar Loske; Tobias Schorsch; Frank Rucktaeschel; Wolfgang Schulze; Burkhard Riefel; Vera van Ackeren; Christian Theodor Mueller Journal: Endosc Int Open Date: 2018-07-04
Authors: Chris-Henrik Wulfert; Christian Theodor Müller; Ahmed Farouk Abdel-Kawi; Wolfgang Schulze; Henning Schmidt-Seithe; Sonko Borstelmann; Gunnar Loske Journal: Innov Surg Sci Date: 2020-10-01