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Operative solution of late consequences of the Tuffier fistula

DOI: 10.22591/magyurol.2016.4.hajdue.199

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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