{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T04:04:05Z","timestamp":1772769845132,"version":"3.50.1"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Adv Skin Wound Care"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:sec>\n            <jats:title>OBJECTIVE<\/jats:title>\n            <jats:p>To review the literature about combined urologic and reconstructive management of pressure injuries (PIs) with urethral fistulas.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>DATA SOURCES<\/jats:title>\n            <jats:p>Authors searched the PubMed, MEDLINE, EMBASE, and Cochrane databases using the following keywords: \u201cPerineum\u201d or \u201cPerineal\u201d and \u201cPressure Ulcers\u201d or \u2018\u2019 Pressure Injury\u2018\u2019 and \u201cUrethral Fistula.\u201d<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>STUDY SELECTION<\/jats:title>\n            <jats:p>The search yielded a total of 95 articles. Study selection followed the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement, and the study was designed according to the PICOS (Population, Intervention, Comparison, Outcomes, Study) guidelines. Congress abstracts, letters to the editor, and editorial comments were excluded. After screening, a total of 9 studies (30 patients) were included in the review.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>DATA EXTRACTION<\/jats:title>\n            <jats:p>Included patients received treatment for a perineal or ischial PI associated with a urinary fistula. The outcomes were recovery, complications, treatment failure, recurrence, and illness-related death.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>DATA SYNTHESIS<\/jats:title>\n            <jats:p>Pressure injuries were mainly ischiatic (50%) and perineal (43%). Forty-six percent of patients had spinal cord injuries, and at least 40% reported voiding dysfunction. Sixteen percent had previous ischiectomy. Flaps such as posterior thigh flap, biceps femoris flap, and inferiorly based transverse rectus abdominal muscle flap had 88% to 100% success rates when used with urinary diversion techniques. Suprapubic cystostomy, the simplest method of urinary diversion, was successful in 47% of cases when performed alone and in 100% when combined with a pedicled omental flap or a transverse rectus abdominal muscle flap.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS<\/jats:title>\n            <jats:p>Prevention and wound care are essential for PI management, but when combined with a urinary fistula, surgical management is unavoidable. Urinary diversion is essential before undergoing any type of ulcer reconstruction. Urethral reconstruction showed favorable results, further strengthened when combined with a musculocutaneous flap.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/asw.0000000000000023","type":"journal-article","created":{"date-parts":[[2023,8,21]],"date-time":"2023-08-21T16:03:04Z","timestamp":1692633784000},"page":"1-8","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["A Systematic Review of Pressure Injuries Associated with Urethrocutaneous Fistula"],"prefix":"10.1097","volume":"36","author":[{"given":"Serge","family":"Zogheib","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nour","family":"Khalil","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georges","family":"Mjaess","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charbel","family":"Feghaly","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bechara","family":"Daou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cyril","family":"Hanna","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marwan","family":"Nasr","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"issue":"1","key":"bib1-20250615","doi-asserted-by":"crossref","first-page":"39e","DOI":"10.1097\/01.prs.0000435843.87927.90","article-title":"Pressure injuries and perineal reconstruction","volume":"133","year":"2014","journal-title":"Plast Reconstr Surg"},{"issue":"1","key":"bib2-20250615","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1007\/s00238-017-1371-2","article-title":"Reconstruction of acquired ischiatic and perineal defects: an anatomical and clinical comparison between gluteal thigh and inferior gluteal perforator flaps","volume":"41","year":"2018","journal-title":"Eur J Plast Surg"},{"issue":"6","key":"bib3-20250615","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1002\/nau.24047","article-title":"Management of urethrocutaneous fistulae complicating sacral and perineal pressure injury in neurourological patients: a national multicenter study from the French-speaking Neuro-urology Study Group and the Neuro-urology Committee of the French Association of Urology","volume":"38","year":"2019","journal-title":"Neurourol Urodyn"},{"issue":"1","key":"bib4-20250615","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/0002-9610(55)90675-9","article-title":"An unusual urethral fistula site","volume":"90","year":"1955","journal-title":"Am J Surg"},{"issue":"4","key":"bib5-20250615","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1016\/S0022-5347(17)42649-8","article-title":"Perineal urethrocutaneous fistula complicating ischiectomy","volume":"139","year":"1988","journal-title":"J Urol"},{"issue":"2","key":"bib6-20250615","doi-asserted-by":"crossref","first-page":"55","DOI":"10.12968\/jowc.2006.15.2.26893","article-title":"Surgical management of ischial and perineal pressure ulcers with urethrocutaneous fistulae","volume":"15","year":"2006","journal-title":"J Wound Care"},{"issue":"1","key":"bib7-20250615","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1097\/00006534-197807000-00015","article-title":"Complications of total ischiectomy for the treatment of ischial pressure sores","volume":"62","year":"1978","journal-title":"Plast Reconstr Surg"},{"issue":"1","key":"bib8-20250615","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1097\/00006534-199289010-00018","article-title":"The inferiorly based rectus abdominis myocutaneous flap for reconstruction of recurrent pressure sores","volume":"89","year":"1992","journal-title":"Plast Reconstr Surg"},{"issue":"5","key":"bib9-20250615","first-page":"326","article-title":"Perineal decubitus ulcer with urethro-cutaneous fistula without bilateral ischiectomy: case report","volume":"24","year":"1986","journal-title":"Paraplegia"},{"issue":"1","key":"bib10-20250615","first-page":"10","article-title":"Urethroplasty using polyglactin mesh in urethral fistula caused by decubitus ulcer of the perineum in spinal cord injuries. 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