Urinary Complications
12 results
1 - 12
Anorectal Disease- You are asked to evaluate a 73-year-old man with a rectourethral fistula confirmed on computed tomography cystogram. It is 2 years since he underwent radiation therapy for prostate cancer. What is the best approach for definitive fistula repair using a muscle flap?
- A 29-year-old healthy man presents to the emergency department with severe anal pain and urinary retention 72 hours after hemorrhoidal banding. His temperature is 101.6°F (38.7°C), heart rate is 120 beats/min, and blood pressure is 80/50 mm Hg. His abdomen is mildly tender in the suprapubic region. Urinary catheter was placed and 750 mL of urine drained. What is the best next step in management?
- A 67-year-old patient presents with a 2-year history of recurrent hemorrhoid swelling, difficulty cleaning, and bright red blood with bowel movements despite fiber supplementation and avoidance of straining. Examination reveals grade III hemorrhoids with a large external component. Which of the following would be the most effective treatment?
- A healthy 41-year-old man presents to your office complaining of blood on the toilet paper after each bowel movement for the past 6 months. On anoscopy, grade II internal hemorrhoids with stigmata of bleeding are found. Which of the following is the most appropriate management?
- A 72-year-old man with obesity underwent an uneventful outpatient 2-quadrant rubber band ligation for bleeding hemorrhoids 4 days ago. He now reports vague perianal pain. Which additional symptom raises the suspicion for procedure-related sepsis?
- A 55-year-old man presents with malaise, fatigue, inability to urinate, temperature of 102°F (38.8°C) and a heart rate of 115 beats/min 4 days after undergoing rubber band ligation for bleeding internal hemorrhoids. What is the next step in management?
- Perioperative
- A 50-year-old man undergoes chemotherapy and radiation for a low T3N1 rectal cancer, followed by a robotic low anterior resection. After surgery, he is placed on an enhanced recovery protocol. When is the most appropriate time for Foley catheter removal from the bladder?
- A 40-year-old man presents to the emergency department with large-volume rectal bleeding and transanal passage of clot 8 days after elective excisional hemorrhoidectomy. He is tachycardic and hypotensive. What is the best next step in management?
- Benign Disease
- A 50-year-old man presents with complaints of recurrent urinary tract infections and pneumaturia. Computed tomography demonstrates a thickened sigmoid colon immediately adjacent to the dome of the urinary bladder. The bladder wall is thickened and an air-fluid level is present within the bladder. His first screening colonoscopy was performed 3 months ago and demonstrated sigmoid diverticulosis with no other suspicious findings. What is the best next step in management?
- A 56-year-old woman with a history of recurrent urinary tract infections presents to the emergency department with tachycardia (heart rate 124 beats/min), hypotension (blood pressure 85/38 mm Hg), diffuse abdominal pain, and frequent watery diarrhea following a course of oral antibiotics. Her abdomen is distended and diffusely tender. Her white blood cell count is 25,000/L (25109/L) and her hemoglobin is 15.0 g/dL (150 g/L). The patient is positive for Clostridioides difficile and is not responding to treatment with 125 mg of oral vancomycin. What is the next best option for this patient?
- A 42-year-old asymptomatic woman has a persistent pouch vaginal fistula, as noted on a pouchogram 3 months after an ileal pouch–anal anastomosis in preparation for a diverting loop ileostomy reversal. Examination under anesthesia reveals no undrained sepsis, normal pouch mucosa, and a fistula with a discrete area of erythema at the pouch anal anastomosis. A biopsy demonstrates Paneth cell reaction, granulation tissue, and active inflammation. What is the best next step?
- Pelvic Floor