# Rectourethral fistula repair



## AngieH (Sep 25, 2012)

Need help with this. Urologist was called into OR by general surgeon who was performing Abdominoperineal resection, because surgeon noticed a trace amount of blood in patient's urine bag. Urologist removed the foley catheeter and noticed the urine to be slightly blood tinged. 
Here is the op report:

Preoperative Diagnosis
1. Bladder laceration
2. Hematuria

Postoperative Diagnosis
Rectourethral fistula.

procedure Performed
1. Cystoscopy
2. Rectourethral fistula repair

Penis was prepped and draped in normal sterile fashion. I inserted the 21-french cystoscope into the patient's urethra and bladder. The penile urethra was noted to be normal up to a 2 to 3 mm defect just outside the patient's external sphincter in the bulbar urethra. His prostatic fossa and bladder mucosa were noted to be completely normal. Patient had clear efflux coming from both ureteral orifices. I thenn slowly backed the cystoscope out of the patient's bladder again into his urethra. Again, I noticed a small defect likely from cautery from 2 o'clock to 4 o'clock at the patient's urethra. Also with irrigation on irrigation could be seen coming into the rectal wound. I then placed the guidewire through the scope and deployed a 16- french council tip catheter over this guidewire and then reconnected it to his GU bag. next, we used 3-0 vicryl in an inerrupted fashion to perform a 3 layer closure of the small rectourethral fistula. This was noted to be watertight at the end of this procedure. The remainder of the APR operation will be dictated by Dr. X. I anticipate leaving the catheter in for at least 2 to 3 weeks postoperatively. I will also recommend at some point in the future external beam radiation to the area to avoid future fistula.

Urologist wants to use code 45820, but I'm thinking 53510. Any suggestions or help would be greatly appreciated.


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