LAUSR

A 70-year-old man presented with a recto-vesical fistula (rectal urinary leakage, pneumaturia, fecaluria). Four days earlier, he had injured himself during anal manipulation with a stick. Endoscopically and cystographically, a transmural perforation, 1.5 cm in diameter, and a fistula canal, 5 cm long, was found (▶Video 1). We started endoscopic negative pressure therapy (ENPT) on Day 5 after injury. The colon was lavaged and urine collection performed with a conventional transurethral urinary catheter. For the first cycle of intracavitary ENPT, we used an open-pore polyurethane foam drain (OPD; EndoSponge; B. Braun, Melsungen, Germany). The customized foam was inserted into the fistula canal through the rectal perforation opening. Negative pressure (–125mmHg, continuous; ActiV.A.C.; KCI, San Antonio, Texas, USA) was applied. At the first drain change after 3 days, the wound surface was debrided with suction and showed an irregular granulation pattern (▶Fig. 1). The sponge had already become very firmly adherent. For this reason, we continued ENPT with an open-pore film drain (OFD). In OFD, a thin perforated double membrane with a liquid-conducting interspace (Suprasorb CNP Drainage Film; Lohmann & Rauscher International GmbH, Neuwied, Germany) is used as the drainage element [1–3] (▶Fig. 2). It has good drainage properties but does not adhere as strongly to the wound. For the first OFD, we wrapped multiple layers of the thin drainage film around the distal end of the tube (▶Fig. 3). The diameter of the drainage element can be adjusted easily to the diameter of the fistula canal by increasing or reducing the number of windings. Very thin as well as large-diameter drains can be prepared in any length [1–3] (▶Fig. 4). The final OFD that was used had a diameter of only 4mm. ENPT with OFD was performed for a further 10 days. After removal of the OFD (▶Fig. 5), the shrinking fistula canal showed typical regular aspiration patterns of the film (▶Fig. 5). After completion of ENPT, the patient continued to irrigate the rectum with an enema twice daily for 1 week [4]. The defect healed completely leaving a tiny scar, with fully preserved organ function of the rectum and bladder [5].