Urinary Complications
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Urinary Complications- Management of Intraoperative Vascular and Urinary Complications
General Postoperative Complications- Local Excision
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?
Core Descriptor Sets for Rectal Prolapse Outcomes Research Using a Modified Delphi Consensus- Hemorrhoids
Anorectal Disease- A 46-year-old man presents to your office with rectal bleeding associated with bowel movements and prolapse of tissue from his anus that spontaneously reduces. Recent colonoscopy demonstrated moderate internal hemorrhoids and a 3-mm tubular adenoma in the sigmoid colon removed with cold forceps. A single rubber band ligation was performed during this procedure. Two days later, he presents to the emergency department with a fever of 102°C, pelvic pain, and urinary retention. The most definitive treatment is
- A 65-year-old patient undergoes rubber band ligation of two hemorrhoid columns on the same day in the office. Three days later the patient calls to report extreme anal pain, fevers, and urinary retention. Which of the following is the best next step for this patient?
- A 40-year-old man presents to the emergency department 4 days after band ligation of a grade 2 internal hemorrhoid with a fever and reports of urinary retention. On evaluation, vital signs indicate temperature 102.2 °F, heart rate of 102 beats per minute, and blood pressure of 114/80 mmHg. Laboratory evaluation is significant for a white blood cell count of 17,000. Physical examination reveals significant anorectal tenderness and swelling. Based on these findings, the best next step in management is
- Male Genitourinary Dysfunction as a Consequence of Colorectal Surgery
- 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?
- Perioperative
- A 55-year-old man undergoes a low anterior resection without diverting ileostomy for an T2N0M0 rectal cancer with anastomosis 5 cm from the anal verge. On postoperative day 10, he presents to the emergency department with low abdominal pain and bloating, decreased bowel function, urinary hesitancy, and low-grade fever. On examination, his heart rate is 90, blood pressure is 110/55 mmHg, and temperature is 100.5 °C. He has some localized low abdominal tenderness. His white blood cell count is 15. Computed tomography (CT) of the abdomen and pelvis with oral, intravenous (IV), and rectal contrast shows a 5-cm perianastomotic abscess with some stranding but no free air. What is the best next step in the management of this patient?
- A 45-year-old man with history of rectal cancer found at 5 cm from the dentate line, underwent low anterior resection. Foley catheter was placed without complication at the start of the surgery. The urine output is appropriate and clear. When should the foley catheter be removed?
- A 77-year-old man has recently undergone a low anterior resection with diverting loop ileostomy for rectal cancer after total neoadjuvant therapy. His hospital course was routine, and he was sent home on postoperative day 4. The patient presents back to the clinic 3 weeks after the index operation. He reports urinary retention, pelvic pain, and bloating. You note an overall failure to thrive. Which test is the most likely to correctly diagnose this patient’s problem?
- Rectal Cancer: Local Excision
- 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?
How to Manage and Prevent Complications- Management of Hemorrhoids (2024)
- Intestinal Stomas
- Anastomotic Complications
- Colonic Diverticular Disease
- Infectious Colitis
- Rectourethral and Complex Fistulas: Evaluation and Management
- Anorectal Crohn’s Disease
- Preoperative Evaluation in Colorectal Patients
- Benign Disease
- Preoperative Preparation
- Anal Cancer
- Quality
- Laparoscopic Rectosigmoidectomy with Transvaginal Specimen Extraction for Intestinal Endometriosis
- Measuring Pelvic Floor Disorder Symptoms Using Patient-Reported Instruments
- Rectal Cancer: Nonoperative Management
- Treatment of Rectal Prolapse (2017)
- Ambulatory Anorectal Surgery (2015)
- Treatment of Left-Sided Colonic Diverticulitis (2020)
- Middle and Anterior Pelvic Compartment: Issues for the Colorectal Surgeon
- Medical Therapy for Crohn’s Disease
- Complications of the Pelvic Pouch
- Sexual Function After Colorectal Surgery in Women
- Optimizing Outcomes with Enhanced Recovery
- Technique of Total Mesorectal Excision
- Pediatric Colorectal Disorders
- Indications for Preoperative Neoadjuvant Therapy
- Pelvic Floor
- Ulcerative Colitis: Surgical Management
- Surgical Management of Ulcerative Colitis (2021)
- Sexual Dysfunction and Its Management
- Rectal Cancer Biology and Hereditary Cancer Syndromes
- Pelvic Floor
- Indications for Extended Resection
- Rectal Prolapse
- Evaluation and Management of Chronic Constipation (2024)
- Indications for Fecal Diversion
- Considerations for Geriatric Patients Undergoing Colorectal Surgery