ENDOSCOPIC USE OF CYANOACRYLATE GLUE IN THE TREATMENT OF URETHRAL FISTULA
André Ramos Sorgi Macedo, Silvio Henrique Maia de Almeida, Marco Aurélio de Freitas Rodrigues, Luís Gustavo Toledo, Rafael Agostinho Maioli
Department of Surgery, Division of Urology, State University of Londrina, Londrina, PR, Brazil
Purpose: The aim of this video is to demonstrate an endoscopic and minimally invasive repair of an urethrocutaneous fistula with cyanoacrylate glue.
Int Braz J Urol. 2013; 39 (Video #9): 602-3
The video nicely depicts a minimally invasive technique which may be helpful in select cases of urethral stricture. In this case the urethral tracts were long and of fairly small caliber. Cyanoacrylates are monomers that polymerize quickly when hydrogen ions are present, creating an acrylic resin, which solidifies quickly. They exist in two forms: short-chain cyanoacrylates (methyl-2 orethyl-2) that are rarely used, because of rapid degradation into the toxic breakdown products of cyanoacrylate and formaldehyde and the long-chain cyanoacrylates (n-butyl-2-cyanoacrylate andn-octyl-2-cyanoacrylate) that degrade more slowly, with minimal toxic buildup (1). As a result, the long-chain cyanoacrylates are safe and are commonly used for skin closure in both urologic and non-urologic surgeries (2). The use of long-chain cyanoacrylates does not seem to compromise subsequent surgeries should they become necessary (3). Care must be taken not to leave behind excess material in bladder as there is a risk for stone formation. A recent report describes use of N-butyl-2-cyanoacrylate followed by fibrin glue for the treatment of post- prostatectomy vesicourethral anastomotic leaks (4). In their series of ten patients they covered the cyanoacrylate with a layer of fibrin glue and achieved good results.
Dr. Hubert Swana