Editing Functional: Urinary Fistulae (section)

== Background ==

* '''Definition of fistula: an extra-anatomic communication between two or more epithelial- or mesothelial-lined body cavities or the skin surface'''
* '''<span style="color:#ff0000">Management principles</span>'''
** '''<span style="color:#ff0000">Factors to consider in the initial approach to urinary fistula and in those patients in whom primary therapy has failed </span><span style="color:#0000ff"> Fistula TO MIIND (8):</span>'''
**# '''<span style="color:#ff0000">Presence of a </span><span style="color:#0000ff">F<span style="color:#ff0000">oreign body</span>'''
**# '''<span style="color:#0000ff">T</span><span style="color:#ff0000">echnical surgical problems</span>'''
**# '''<span style="color:#ff0000">Urinary </span><span style="color:#0000ff">O</span><span style="color:#ff0000">bstruction</span>; remove or bypass distal urinary obstruction'''
**# '''<span style="color:#0000ff">M</span><span style="color:#ff0000">alignancy; beware of malignant cause of fistula</span>''' 
**#*'''<span style="color:#ff0000">Biopsy of the fistula tract should be performed in any patient with a fistula and a prior history of malignancy</span>'''
**# '''<span style="color:#0000ff">I</span><span style="color:#ff0000">schemia or </span><span style="color:#0000ff">I</span><span style="color:#ff0000">nfection</span>'''
**# '''<span style="color:#0000ff">N</span><span style="color:#ff0000">utrition</span>'''
**# '''<span style="color:#0000ff">D</span><span style="color:#ff0000">rainage</span>; achieve unobstructed urinary drainage and/or stenting'''
** '''<span style="color:#ff0000">Principles of Surgical Repair of Urinary Fistula (11):'''
**# Adequate '''exposure''' of the fistula tract
**# '''Debridement of devitalized and ischemic tissue'''
**# '''Removal of involved foreign bodies''' or synthetic materials from region of fistula, if applicable
**# Careful dissection and/or anatomic '''separation of the involved organ cavities'''
**# '''Watertight closure'''
**# Use of well-vascularized, '''healthy tissue flaps for repair''' (atraumatic handling of tissue)
**# '''Multiple-layer closure'''
**# '''Tension-free, nonoverlapping suture lines'''
**# Adequate urinary tract '''drainage and/or stenting after repair'''
**# '''Treatment and prevention of infection''' (appropriate use of antimicrobials)
**# Maintenance of '''hemostasis'''