Vacuum-assisted closure therapy in ureteroileal anastomotic leakage after surgical therapy of bladder cancer.
BACKGROUND
Vacuum-assisted closure (VAC) is an acknowledged method of treating wound healing disorders, but has been viewed as a contraindication in therapy of intraabdominal fistulas.


METHODS
We present the case of an 83-year old patient with ureteroileal anastomotic insufficiency following cystectomy and urinary diversion by Bricker ileal conduit due to urothelial bladder cancer. After developing an open abdomen on the 16th postoperative day a leakage of the ureteroileal anastomosis appeared that cannot be managed by surgical means. To stop the continued leakage we tried a modified VAC therapy with a silicon covered polyurethane foam under a suction of 125 mmHg. After 32 days with regularly changes of the VAC foam under general anesthesia the fistula resolved without further problems of ureteroileal leakage.


CONCLUSIONS
We present the first report of VAC therapy successfully performed in urinary tract leakage after surgical treatment of bladder cancer. VAC therapy of such disorders requires greater care than of superficial application to avoid mechanical alterations of internal organs but opens new opportunities in cases without surgical alternatives.
Denzinger
Stefan
S
Department of Urology, University of Regensburg, Regensburg, Germany. stefandenzinger@gmx.de
Luebke
Lars
L
Burger
Maximilian
M
Kessler
Sigurd
S
Wieland
Wolf F
WF
Otto
Wolfgang
W
D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects* / Q000379:methods; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000601:surgery*; D015653:Cystectomy / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects* / Q000379:methods