Transanal endoscopic microsurgery for surgical repair of rectovesical fistula following radical prostatectomy.

BACKGROUND: Rectovesical fistula is a rare complication following prostatectomy, associated with significant symptoms such as urinary drainage from anus or faecaluria. While several surgical procedures have been described to treat this condition, none of them has been accepted as the universal standard. Transanal endoscopic microsurgery (TEM) is a well-established endoluminal procedure for local excision of rectal tumors. But its application to the repair of rectovesical fistula has been almost unknown. METHODS: We performed TEM as a surgical repair for refractory rectovesical fistula developing after radical prostatectomy in 10 patients. Under the magnified three-dimensional view, through the stereoscope, the fistula and the surrounding rectal mucosa were precisely resected. The defect and the muscle layer of the rectum were closed by hand-sew technique in four layers. RESULTS: Fistula was completely closed in 7 patients, who eventually underwent enterostomy closure, while in the other 3 patients the fistula recurred. In the three recurrent cases, the fistula was associated with wide, tough scar tissue due to previous irradiation, HIFU, or repeated surgical repair attempts. CONCLUSIONS: Rectovesical fistulas associated with wide, tough scar tissue due to multi-time attempt of surgical repair or any type of energy ablation should not be indicated for repair by TEM. However, for simple fistulas without tough, fibrotic surroundings, TEM can be indicated as a minimally invasive surgical option with very low morbidity, without any incision in healthy tissue for approach.

[A case of long-term survival of advanced penile carcinoma treated with combination therapy].

A 72-year-old man with genital ulcerative tumor was introduced to our hospital in December 1997. The pathological examination revealed well differentiated squamous cell carcinoma. A diagnosis by computed tomography and magnetic resonance imaging indicated that a locally advanced penile carcinoma had infiltrated the urethra, prostate, pubic bone and there was also bilateral inguinal lymphoadenopathy. Linac irradiation (40Gy/4 weeks) combined with once-a-week administration of THP-ADM were indicated. One month after the combination therapy, the tumor size had become small enough to allow curative surgical treatment. Pathological examination revealed no positive margin. For eight years since this radical treatment, the patient has been healthy with no local recurrence and no distant metastatic lesion.