Table 1 Timeline of patient’s medical history and course of care
From: An interesting case of vesical fistula complicating urogenital tuberculosis
Date | Relevant past medical history and interventions | ||
|---|---|---|---|
04/2017 | Past history of bladder trauma following accidental fall 1Â year back Emergency laparotomy with bladder repair done (intraoperative details not available) and patient kept on SPC in postoperative period After removal of SPC, patient was not able to void for which catheter was replaced | ||
Date | Summaries from initial and follow-up visit | Diagnostic testing | Interventions |
|---|---|---|---|
Visit-1 05/2018 | C/o increased frequency and dysuria since 3Â years H/o Leakage of urine from suprapubic catheter side P/A-unhealthy lower midline scar with large incisional hernia with leaking SPC site L/E-enlarged nodular left epididymis | Investigation including Urine R/M, RFT and USG KUB sent | Managed conservatively |
Visit-2 05/2018 | C/o increased frequency and dysuria since 3 years H/o Leakage of urine from suprapubic catheter side | Serum creatinine- 2.1 mg/dl USG KUB-Bilateral hydronephrosis (right > left) with a small capacity bladder NCCT KUB-Right kidney—Grossly hydronephrotic, multiple dilated calyces, small contracted pelvis Right Ureter—diffusely thickened ureter, mild left hydronephrosis, no identifiable bladder | Managed conservatively Plan for MCUG and cystourethroscopy |
Visit-3 06/2018 | C/o increased frequency and dysuria since 3 years H/o Leakage of urine from suprapubic catheter side | MCUG- small capacity bladder with multiple fistulous tracts into the abdominal wall, left grade III reflux, dilated prostatic fossa with intravasation into the left seminal vesical | Cystourethroscopy–urethrocutaneous fistula at proximal penile level with dilated proximal urethra with no verumontanum being made out and distorted bladder neck. small bladder capacity with multiple fistulous tract openings. Ureteric orifice not visible Random bladder biopsy taken Urine for AFB and culture sent |
Visit-3 06/2018 | C/o increased frequency and dysuria since 3 years H/o Leakage of urine from suprapubic catheter side | Urine for AFB (3 consecutive overnight samples)—Positive Urine culture for Mycobacterium tuberculosis—Positive Random Bladder Biopsy—showing caseating granulomas | Multi-drug anti-tubercular therapy (ATT) started Plan for definitive surgery after initial phase of ATT |
Visit-4 09/2018 | C/o increased frequency and dysuria since 3Â years H/o Leakage of urine from suprapubic catheter side | Pre-anesthetics clearance taken | Right-sided Nephrectomy followed by Ileal conduit formation done under general anesthesia Continue ATT |
Visit-5 10/2019 | Symptoms improved Wound healthy | Serum creatinine-1.65 | Advice regular follow-up every 6 monthly |