A novel technique for negotiation of a complex fistula-in-ano using a flexible ureteral catheter

TECHNIQUE On examination, the external opening is identifi ed and hydrogen peroxide instillation is used to detect an internal opening. The fl exible end of a 0.89mm diameter urological guidewire coated in polytetrafl uoroethylene (Boston Scientifi c, Natick, MA, US) is inserted through the internal opening. Using manual palpation and artery forceps, the guidewire is advanced until it protrudes beyond the external opening. Following this, a 6Fr open-end ureteral catheter (Cook Medical, Bloomington, IN, US) is advanced over the guidewire. A 1/0 nylon suture is passed through the lumen of the catheter and a loop is tied in the distal end of the suture (Fig 1), allowing a vascular sling to be pulled through the track, from the internal to the external opening (Fig 2). This is then fi xed to form a loose seton (Fig 3).