title: Urinary-cutaneous Fistulae in Patients With Neurogenic Bladder.
abstract: OBJECTIVE
  To review our experience with neurogenic bladder (NGB) patients who developed urinary-cutaneous fistulae (UCF). Patients with NGB can form UCF of multiple etiologies; however, little is known about the characteristics or long-term outcomes of these defects.
  
  
  METHODS
  We reviewed 21 patients with NGB who developed UCF between 1998 and 2013. The clinical end points of the study were development of UCF, fistula repair failure, and need for permanent urinary diversion. Possible risk factors associated with repair failures were examined.
  
  
  RESULTS
  We evaluated 21 patients with a mean age of 39.5 years (23-76) and median follow-up of 67 months (1-179). Causes of UCF included decubitus ulcers (7), wound infections or abscess formation (5), condom catheter complications (4), traumatic catheterization (4), and pelvic trauma (1). Thirteen patients had their fistulae repaired surgically, with 9 patients eventually requiring urinary diversion with a suprapubic (SP) tube (7) or ileal conduit (2) (9 of 13, 69%). Eight patients had their urine diverted upon presentation, with ileal conduit (5 of 8, 63%), SP tube (2 of 8, 25%), or perineal urethrostomy (1 of 8, 12%). In total, 17 eventually required permanent surgical or SP tube urinary diversion (81%), of which 9 were with an SP tube (53%), 4 with an ileal conduit (23%), 3 with a conduit catheter (18%), and 1 with a perineal urethrostomy (6%).
  
  
  CONCLUSIONS
  UCF repairs in patients with NGB are a challenge to manage. Patients who undergo surgical repair of their fistula are likely to require repeat repairs with eventual need for a permanent urinary diversion.
authors.affiliation: Department of Surgery, Division of Urology, Brigham and Women's Hospital Harvard Medical School, Boston, MA. Electronic address: vraup@partners.org.
authors.forename: Valary T
authors.initials: VT
authors.lastname: Raup
authors.affiliation: Department of Surgery, Division of Urology, Brigham and Women's Hospital Harvard Medical School, Boston, MA.
authors.forename: Jairam R
authors.initials: JR
authors.lastname: Eswara
authors.affiliation: Department of Surgery, Division of Urology, Washington University School of Medicine, St. Louis, MO.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Weese
authors.affiliation: Department of Surgery, Division of Urology, Washington University School of Medicine, St. Louis, MO.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Potretzke
authors.affiliation: Department of Surgery, Division of Urology, Washington University School of Medicine, St. Louis, MO.
authors.forename: Steven B
authors.initials: SB
authors.lastname: Brandes
mesh_terms: D000328:Adult; D000368:Aged; D017577:Cutaneous Fistula / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000293:injuries; D003668:Pressure Ulcer / Q000150:complications; D001747:Urinary Bladder Fistula / Q000209:etiology* / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000150:complications*; D014546:Urinary Catheterization / Q000009:adverse effects; D062885:Urinary Catheters / Q000009:adverse effects; D014547:Urinary Diversion; D014946:Wound Infection / Q000150:complications; D055815:Young Adult