Successful management of a high-output urinary fistula following radical cystectomy and ileal conduit: a conservative approach

BMJ Case Rep. 2021 Dec 30;14(12):e244617. doi: 10.1136/bcr-2021-244617.

Abstract

Urinary leak following ileal conduit after a radical cystectomy is a rare yet serious complication which presents early in the postoperative period. We herein present a case of a 38-year-old man diagnosed with recurrent high-grade non-muscle invasive bladder carcinoma. He underwent robot-assisted radical cystectomy and bilateral pelvic lymph node dissection. Postoperatively, the patient developed a high output urinary fistula (800-1000 mL/day) which was confirmed by fluid creatinine levels and a contrast study. He was managed successfully with a conservative approach. The leak subsided in 6 weeks and on follow-up patient is doing well. Most of the literature favours a surgical approach in such cases, however with optimal nutritional support (enteral/parenteral), adequate diversion of urine, percutaneous drainage of undrained collections, adequate intravenous antibiotics and good nursing care, resurgery with its associated morbidity can be avoided resulting in successful outcomes.

Keywords: cancer intervention; urological cancer; urological surgery; urology.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Cystectomy
  • Humans
  • Male
  • Neoplasm Recurrence, Local
  • Urinary Bladder / diagnostic imaging
  • Urinary Bladder / surgery
  • Urinary Bladder Neoplasms* / surgery
  • Urinary Diversion* / adverse effects
  • Urinary Fistula* / etiology
  • Urinary Fistula* / surgery