Management of urethrocutaneous fistulae complicating sacral and perineal pressure ulcer in neurourological patients: A national multicenter study from the French‐speaking Neuro‐urology Study Group and the Neuro‐urology committee of the French Association of Urology

• Published in: Neurourology and urodynamics Vol. 38; no. 6; pp. 1713 - 1720
• Main Authors: Gambachidze, Dimitri, Lefèvre, Chloë, Chartier‐Kastler, Emmanuel, Perrouin Verbe, Marie‐Aimée, Kerdraon, Jacques, Egon, Guy, Even, Alexia, Denys, Pierre, Castel‐Lacanal, Evelyne, Gamé, Xavier, Ruffion, Alain, Hascoet, Juliette, Peyronnet, Benoit, Chaussard, Haude, Verde, Kévin Lo, Karsenty, Gilles, Phé, Véronique
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.08.2019
• Subjects: Adult; Comorbidity; Cutaneous Fistula - complications; Cutaneous Fistula - epidemiology; Cutaneous Fistula - surgery; Epidemiology; Female; Fistulae; France - epidemiology; Humans; Male; Middle Aged; Nervous System Diseases - complications; Nervous System Diseases - epidemiology; Nervous System Diseases - surgery; Patients; Perineum; Pressure; pressure ulcer; Pressure Ulcer - complications; Pressure Ulcer - epidemiology; Pressure Ulcer - surgery; Pressure ulcers; Pyelonephritis; Rehabilitation; Retrospective Studies; Sacrococcygeal Region; Sacrum; Socioeconomic Factors; spinal cord injury; Surgery; Treatment Outcome; Urethral Diseases - complications; Urethral Diseases - epidemiology; Urethral Diseases - surgery; urethral fistulae; urinary diversion; Urinary Diversion - methods; Urology; France; spinal cord injury; urethral fistulae; perineum; sacrum; pressure ulcer; urinary diversion
• ISSN: 0733-2467; 1520-6777
• DOI: 10.1002/nau.24047

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.