PMC9807334_01
Abdominal computed tomography images (a: axial; b: sagittal) demonstrating vesical calculi (white arrows), a vesical diverticulum calculus (black arrow), and abnormal changes suspected to indicate a vesicocutaneous fistula (white circle).
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Computed tomography revealed multiple vesical stones (maximum diameter: 4.1 cm), and vesical diverticulum with stones located on the ventral side as well as an aberrant connection between the anterior bladder wall and the external surface of the skin, which was thought to be caused by the enlarged prostate (calculated volume: 79 mL; Fig. 1ab).
Surgical procedure used in this case. (a) We approached the space of Retzius via a midline incision in the lower abdomen and an incision centered on the fistula in the lower right abdomen. (b) The infected wound including the fistula and the vesical diverticulum were removed en bloc. (c) After releasing the bladder, all the vesical calculi were removed. (d) The infected tissues were debrided and the incisions were closed.
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To secure an adequate field of view and to remove the infectious tissue en bloc, we made a midline incision in the lower abdomen and an oblique incision centered on the opening of the fistula, following the advice of the reconstructive surgery team (Fig. 2a). To control infection, the abdominal wall tissues around the fistula and the vesical diverticulum were removed en bloc, and we retained as much normal tissue as possible (Fig. 2b). The vesical stones were also removed (Fig. 2c). The inside of the bladder was washed with saline, and the bladder wall was sutured (Fig. 2d).
Photograph showing multiple vesical diverticulum calculi and vesical calculi (maximum diameter: 4.1 cm).
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We removed 72 stones, which were brown-colored and had a maximum diameter of 4.1 cm (Fig. 3).