Operative solution of late consequences of the Tuffier fistula
Hajdú Erzsébet dr., Bajory Zoltán dr., Fehér Ádám dr., Pajor László dr. ( Szegedi Tudományegyetem, Urológiai Klinika, Szeged ((director: Bajory Zoltán dr.))
Objective: The authors present a case history of the late complications of an obsolote, nearly unforgotten surgical operation method, the Tuffier fistula procedure.
Case report: The 41-year-old woman was born with congenital urogynecological malformations, pseudohermaphroditism, atresia of vagina and urethra. The penis-like clitoris was resected in early childhood and the fistula artificially widened between the bladder and rectum with Tuffier method. The mixture of urine and faces was passed through anal sphincter and this secured the continence. In 1991 a coloplastic vaginal substitution was performed without connection with the uterus. She was admitted to the Department of Urology as an adult for febrile episodes, abdominal pain – especially during menstruation – and elevation of serum creatinine level. The MR scan revealed a shrunken left kidney, communication between the uterus, the small bladder and the rectum. In 2013 a Bricker-bladder was created and this operation decreased temporarily the creatinine level, but through the persistant Tuffier fistula faces was passed into the uterine cavity. At a second session, the bladder remnant and the uterus were removed and the fistula closed. This intervention stopped the febrile episodes and the painful menstruation.
Conclusion: The Tuffier fistula procedure now is an obsolete surgical method with predictable late consequences. The remodelling of these is a surgical challenge, needs complex and multiple surgical operations in most cases.
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