One of the Useful Methods for Repairing the Perineal Urinary Fistula

Yang, Kou Young; Kim, Kee Soo

Abstract

Even though surgical treatment is performed skillfully and thoroughly in repairing urethral ailments such as hypospadia, urethral rupture, urethral stricture, urethral calculus, urethral foreign body and periurethral abscess, these often lead not only to urethral stricture but also to the development of urinary fistula. And the difficulty of surgical treatment for urinary fistula hasoften been reported. In spite of the fact that much work has been devoted to establish a surgical modification for repairing the perineal urinary fistula, no satisfactory result has been reported, and it is generally agreed that there is no standard procedure of urethroplasty or any method of closing the urinary fistula of the urethra Among these conditions which lead to the development of urinary fistula, the most important factors are supposed to be (1) contamination of the repaired wound by infected urine that is more aggravated by prolonged use of urethral splinting catheter and (2) the pressure of urinary stream on the repaired area that seems to be more resistant than normal urethral wall after removing the splinting urethral catheter. In consideration of these factors, the former condition should be prevented by chemotherapy or antibiotics plus proper use of the urethral catheter; the latter condition would be corrected by releasing the pressure on the repaired area. For the purpose of releasing the pressure on this portion, the author instructed the patient to compress the fistular area with soft tennis ball during urination. This paper represent the result obtained from the application of this technique on three cases of the perineal urinary fistula which were complicated after urethral surgery, and all of these case were successfully closed. Finally the author was impressed with the relatively shortened healing time for the fistulas. The author's technique results in the following: (1) a decreased urinary pressure on the repaired woundarea, (2) prevention of a widening of the urinary fistula and (3) promotion of wound healing in perifistular tissue by preventing the urinary contamination.