I am a 50 year old male paraplegic for 27 years. I have been self intermittent catheterizing every 4 hours since day one. Due to chronic constipation a creation of colostomy 13 years ago. Had rectum removed due to drainage 9 years ago.

January of 2012 where the rectum used to be the area opened up and started draining. Rectal surgeon assumed the drainage must of been coming from the surgery 9 years ago that must not of healed properly. His method of treatment was to surgically open up the cavity and leave it open to drain. We packed it to help keep it open so it would heal from inside before the skin would heal over.

Nearly a year later we thought it was healed but then it opened up again January 2013. Did the surgery again to open it up to drain and packed it again. 3 months later we once again thought it was almost healed and then it opened up and started draining again. At this time the rectal surgeon decided to run some test. He first had a cat scan of the lower pelvic with dye injected into blood stream and also drank some contrast liquid. The scan never showed anything of concern.

The rectal surgeon then ordered a Fistulogram where they injected dye into the open unhealed cavity in the rectum area. The dye traveled up a very narrow channel into a cavity and then had a couple small branches off it that was unknown for sure where it lead to. After the test the radiologist told me that he thinks the cavity is being fed by something, either bowel or bladder.

My Rectal surgeon called me after he received the written report and said that I need to see a plastic surgeon and get a skin flap to permanently get this closed up. I had concerns about seeing the Plastic Surgeon but went along with his request.

At the first visit with the Plastic Surgeon he was all ready to schedule a skin flap surgery. But i told him a skin flap is going to be my last resort and that I am not so sure that this caivity isn't being fed by the bladder or something like the radiologist suggested. He said the radiologist report doesn't show anything like that. I asked if the same person wrote the report that did the test. He said no it was someone else. I told him to talk to the person that did the test and examine the reports more.

Plastic Surgeon then agreed to order a Urethra-gram where they injected dye into the urethra to check for leaks and also did the colon with dye through the stoma. The colon test didn't turn out very good because they weren't able to get a good flow into the colon through the stoma. it kept leaking out the top of the stoma. But from what they could tell the colon was not leaking internally.

The Urethra-gram did show a leak. It wasn't a clearly defined where the urethra was leaking but the radiologist saw pockets develop as the dye was being injected into the urethra. With further studying of all my films from all my test they are pretty sure that the urethra is feeding this cavity that won't heal and it is then draining out the area rectum was.

After the Plastic Surgeon got the reports of the test he called me and said it does appear that the Urethra is leaking into this cavity. He said he talked with two different Urologists and they both said the surgery to fix the leak would be pretty involved surgery. For a more conservative plan they said I could get a indwelling Foley catheter so it will block the leak and then to see the Wound Center. The wound center would hook me up to a vac to force the cavity to drain.

I have not yet seen the Urologist or the Wound Center. My questions for the Urologist is going to be what does involved surgery mean? What type of surgery would fix this urethra leak? Would the surgery permanently fix the leak? If I get a foley catheter will that allow the leak to heal someday and then I go back to intermittent catheterization? Is a Urostomy a option? Would like to hear from anyone who has Urostomy. What are the pros and cons?

My thought of the indwelling Foley is that it could still possibly leak around the foley and into the leaking urethra. Once we get the cavity healed I don't want any risk of a leak again. I am thinking I need to look into whatever the involved surgery might be the plastic surgeon was talking about. I am leaning towards the Urostomy for a permanent fix but want to hear from others who are experienced with this. Anyone have one or know anything about Urostomy or have a better solution to my finally somewhat diagnosed problem? Thanks