Dimitri Gambachidze1, Chloë Lefèvre2, Emmanuel Chartier-Kastler1,3, Marie-Aimée Perrouin Verbe4, Jacques Kerdraon5, Guy Egon6, Alexia Even3, Pierre Denys3, Evelyne Castel-Lacanal7, Xavier Gamé8, Alain Ruffion9, Juliette Hascoet9, Benoit Peyronnet10, Haude Chaussard11, Kévin Lo Verde12, Gilles Karsenty12, Véronique Phé1. 1. Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Médecine Sorbonne Université, Paris, France. 2. Department of Physical Medicine and Rehabilitation, CHU de Nantes, Nantes, France. 3. Department of Physical Medicine and Rehabilitation, Raymond Poincaré Academic Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Ouest Medical School, Versailles-Saint-Quentin en Yvelines University, Montigny le Bretonneux, France. 4. Department of Urology, CHU de Nantes, Nantes, France. 5. Department of Physical Medicine and Rehabilitation, Kerpape Hospital, Ploemeur, France. 6. Department of Physical Medicine and Rehabilitation, Rehabilitation Centre of L'Arche, Saint Saturnin, France. 7. Department of Physical Medicine and Rehabilitation, CHU Rangueuil, Toulouse, France. 8. Department of Urology, CHU Rangueil, Toulouse, France. 9. Department of Urology, Lyon Sud Hospital, Lyon University Hospital, Lyon, France. 10. Department of Urology, CHU Rennes, Rennes, France. 11. Department of Orthopedic Surgery, Raymond Poincaré Academic Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. 12. Department of urology, Aix Marseille Université, Marseille, France.
Abstract
PURPOSE: To describe the epidemiologic characteristics of urethrocutaneous fistulae (UCF) in sacro-perineal pressure ulcer (SPPU) in neurourological patients and to assess outcomes after surgical urinary diversion. MATERIALS AND METHODS: Through the French-speaking Neurourology Study Group and Association of Urology network, a retrospective multicenter study in nine major urology and physical medicine and rehabilitation (PMR) units was conducted. All patients with SPPU associated with UCF between 2000 and 2016 were included. Data concerning: sociodemography, clinical, medical and biological comorbidities, neurological and urological history, pressure ulcer characteristics, and finally urinary diversion surgery were collected. Complications and SPPU healing/relapse were assessed. RESULTS: In all, 74 patients were included. The median age on diagnosis: 45.9 years (interquartile range [IQR], 38.7-53.4) and median follow-up: 15.1 months (IQR, 5.7-48.8). A psychiatric disorder was the most frequent comorbidity (44.6%). Only 59.5% and 50% had regular PMR and urologic follow-up, respectively. Seventy-one patients (95.9%) underwent urinary diversion surgery. Among those, relapse occurred in 15 (21.1%) at the end of the follow-up. The diversion was noncontinent in 85.9%. The major complications rate was 26.8%. A total of 30 late complications in 21 patients were reported. The most frequent was obstructive pyelonephritis (n = 9). All of the patients who underwent surgical diversion without cystectomy (n = 5) developed a pyocyst. Finally, the pressure ulcer healing rate when patients underwent both urinary diversion and pressure ulcer surgery was 74.4%. CONCLUSIONS: Our retrospective data suggest that UCF complicating SPPU is a rare and severe pathology. The combination of radical urinary diversion with cystectomy and pressure ulcer surgery should be performed as often as possible.
PURPOSE: To describe the epidemiologic characteristics of urethrocutaneous fistulae (UCF) in sacro-perineal pressure ulcer (SPPU) in neurourological patients and to assess outcomes after surgical urinary diversion. MATERIALS AND METHODS: Through the French-speaking Neurourology Study Group and Association of Urology network, a retrospective multicenter study in nine major urology and physical medicine and rehabilitation (PMR) units was conducted. All patients with SPPU associated with UCF between 2000 and 2016 were included. Data concerning: sociodemography, clinical, medical and biological comorbidities, neurological and urological history, pressure ulcer characteristics, and finally urinary diversion surgery were collected. Complications and SPPU healing/relapse were assessed. RESULTS: In all, 74 patients were included. The median age on diagnosis: 45.9 years (interquartile range [IQR], 38.7-53.4) and median follow-up: 15.1 months (IQR, 5.7-48.8). A psychiatric disorder was the most frequent comorbidity (44.6%). Only 59.5% and 50% had regular PMR and urologic follow-up, respectively. Seventy-one patients (95.9%) underwent urinary diversion surgery. Among those, relapse occurred in 15 (21.1%) at the end of the follow-up. The diversion was noncontinent in 85.9%. The major complications rate was 26.8%. A total of 30 late complications in 21 patients were reported. The most frequent was obstructive pyelonephritis (n = 9). All of the patients who underwent surgical diversion without cystectomy (n = 5) developed a pyocyst. Finally, the pressure ulcer healing rate when patients underwent both urinary diversion and pressure ulcer surgery was 74.4%. CONCLUSIONS: Our retrospective data suggest that UCF complicating SPPU is a rare and severe pathology. The combination of radical urinary diversion with cystectomy and pressure ulcer surgery should be performed as often as possible.