title: The staged management of complex entero-urinary fistulae.
abstract: OBJECTIVE
  To present the results of the staged management of complex entero-urinary fistulae.
  
  
  METHODS
  Ten patients with complex entero-urinary fistulae were reviewed; all patients were referred to a national intestinal failure unit after failed treatment in other centres. Each patient was treated in three stages. The acute stage involved proximal defunctioning and distal drainage of both the gastrointestinal and urinary tracts to isolate the fistula, together with the eradication of sepsis. The recovery stage involved total parenteral nutrition, organ support, radiological planning of surgical reconstruction and intensive nursing. The reconstructive stage followed when the patient was stable, nutritionally replenished and intra-abdominal sepsis was controlled. Surgery was undertaken jointly by urological and gastrointestinal surgeons.
  
  
  RESULTS
  The fistulae were treated successfully in all patients, with functional restoration in four, and/or diversion of the gastrointestinal and urological tracts in six. The mean (range) time to reconstruction was 5 (1-20) months. There were no postoperative deaths.
  
  
  CONCLUSIONS
  A staged multidisciplinary approach with delayed reconstruction can achieve a successful outcome in the management of complex entero-urinary fistulae.
authors.affiliation: Department of Urological Surgery, and Intestinal Failure Unit, Hope Hospital, Salford Royal Hospitals Trust, Salford, UK. dshackley@picr.man.ac.uk
authors.forename: D C
authors.initials: DC
authors.lastname: Shackley
authors.forename: C J
authors.initials: CJ
authors.lastname: Brew
authors.forename: A A
authors.initials: AA
authors.lastname: Bryden
authors.forename: I D
authors.initials: ID
authors.lastname: Anderson
authors.forename: G L
authors.initials: GL
authors.lastname: Carlson
authors.forename: N A
authors.initials: NA
authors.lastname: Scott
authors.forename: N W
authors.initials: NW
authors.lastname: Clarke
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D019651:Plastic Surgery Procedures / Q000379:methods; D018805:Sepsis / Q000209:etiology / Q000628:therapy; D013524:Surgical Flaps; D016896:Treatment Outcome; D014548:Urinary Fistula / Q000209:etiology / Q000601:surgery*