Outcomes of gracilis muscle interposition for rectourethral fistulas caused by treatment of prostate cancer.

BACKGROUND: Gracilis muscle interposition (GMI) has been associated with favorable outcomes in treating complex perianal fistulas. Outcomes of GMI may vary according to the fistula etiology, particularly between rectovaginal fistulas in women and rectourethral fistulas (RUF) in men. The aim of this study was to assess the outcome of GMI to treat RUF acquired after prostate cancer treatment. METHODS: This retrospective cohort study included male patients treated with GMI for RUF acquired after prostate cancer treatment between January 2000 and December 2018 in the Department of Colorectal Surgery, Cleveland Clinic Florida. The primary outcome was the success of GMI, defined as complete healing of RUF without recurrence. Secondary outcomes were length of hospital stay and postoperative complications. RESULTS: This study included 53 male patients with a median age of 68 (range, 46-85) years. Patients developed RUF after treatment of prostate cancer with radiation (52.8%), surgery (34%), or transurethral resection of the prostate (TURP) (13.2%). Median hospital stay was 5 (IQR, 4-7) days. Twenty (37.7%) patients experienced 25 complications, the most common being wound infection and dehiscence. Primary healing after GMI was achieved in 28 (52.8%) patients. Fifteen additional patients experienced successful healing of RUF after additional procedures, for a total success rate of 81.1%. Median time to complete healing was 8 (range, 4-56) weeks. The only significant factor associated with outcome of GMI was wound dehiscence (p = 0.008). CONCLUSIONS: Although the initial success rate of GMI was approximately 53%, it increased to 81% after additional procedures. Complications after GMI were mostly minor, with wound complications being the most common. Perianal wound dehiscence was significantly associated with failure of healing of RUF after GMI.

Rectourethral fistula after external beam radiotherapy for prostate cancer in a patient with thromboangiitis obliterans: A case report.

INTRODUCTION: Thromboangiitis obliterans (TAO) is a rare disease of unknown cause that causes segmental vasculitis in peripheral blood vessels. It is uncertain whether its presence causes serious adverse events in patients receiving external beam radiotherapy. PATIENT CONCERNS: A 73-year-old Japanese man with prostate cancer underwent external beam radiotherapy. DIAGNOSIS: After completion of radiotherapy, fingertip pain occurred, leading to the diagnosis of TAO. INTERVENTIONS: The patient was instructed to stop smoking, but was unable to do so. OUTCOMES: Nine months after the completion of radiotherapy, fecaluria appeared, and a rectourethral fistula was diagnosed by contrast enema. The patient's TAO was poorly controlled, and the patient died from aspiration pneumonia 33 months after completion of the radiotherapy regimen. No tumor recurrence was observed during this process, and there were no risk factors other than TAO that may have formed a rectourethral fistula. LESSONS: This is the first report of rectourethral fistula caused by external beam radiotherapy for prostate cancer in which TAO was suspected to be involved. Although little is known about the relationship between TAO and radiotherapy, it should be noted that radiotherapy itself may increase the risk of normal tissue toxicity in patients with TAO.

Treatment for rectourethral fistulas after radical prostatectomy with biological material interposition through a perineal access.

INTRODUCTION: Rectal injury is a rare complication after extraperitoneal laparoscopic radical prostatectomy. The development of rectourethral fistulas (URF) from rectal injuries is one of the most feared and of more complex resolution in urology. MATERIAL AND METHODS: Between 2013 and 2020 we have operated on a total of 5 patients with URF after extraperitoneal endoscopic radical prostatectomy through a perineal access using the interposition of biological material. All fistulas had a diameter of less than 6 mm at endoscopy and were less than 6 cm apart from the anal margin. RESULTS: The mean age of the patients was 64 years old. All patients had a previous bowel and urinary diversion for at least 3 months. Under general anesthesia and with the patient in a forced lithotomy position, fistulorraphy and interposition of biological material of porcine origin (lyophilized porcine dermis [Permacol®]) were performed through a perineal access. Mean operative time was 174 min (140-210). Most patients were discharged on the third postoperative day. The bladder catheter was left in place for a mean of 40 days (30-60). Prior to its removal, cystography and a Gastrografin® barium enema were performed, showing resolution of the fistula in all cases. CONCLUSIONS: The interposition of biological material from porcine dermis through perineal approach is a safe alternative with good results in patients submitted to urethrorectal fistulorraphy after radical prostatectomy.

High rectourethral fistula following TURP: repair possible only after transvesical prostatectomy.

We report a case of iatrogenic rectourethral fistula (RUF) in an elderly man with benign prostatic enlargement and acute urinary retention, following a transurethral resection of prostate (TURP). This patient presented a unique challenge of tackling the RUF in the presence of a large residual prostate gland and urinary tract infection. RUF was repaired only after getting the access to the fistula following transvesical prostatectomy. Follow-up imaging showed well-healed repair of RUF. Transvesical prostatectomy is a useful adjunctive procedure in repair of RUF when associated with a large prostate. This case also highlights the importance of technique selection while planning for surgery on large prostate glands. TURP is not the preferred first modality of choice for larger glands as noted in this case.

Autologous platelet-rich plasma covering urethroplasty versus dartos flap in distal hypospadias repair: A prospective randomized study.

OBJECTIVE: To compare the outcome and complication rate of the platelet-rich plasma applied as a coverage layer and dartos flap layer during primary repair of distal hypospadias. METHODS: A prospective randomized study was carried out comprising 180 boys (age range 12-65 months) from October 2011 to December 2016 at Al-Azhar University Hospitals, Cairo, Egypt. A single surgeon carried out all urethroplasty. Patients were randomly divided into two groups: group A (tubularized incised plate urethroplasty with platelet-rich plasma coverage layer) and group B (ventral dartos flap). Complication rates were compared between two groups. RESULTS: There was a significant difference in the occurrence of complications between the two groups. A total of 36 (20%) complications were recorded in 26 patients, just 12 (13.3%) reported in group A, but 24 (26.7%) complications were reported in group B. Urethrocutaneous fistula was observed in nine patients (10%) in group A, and 12 (13.3%) in group B. Partial glans dehiscence occurred in one patient in group A, and four patients in group B. No patient in group A had a superficial wound infection, compared with six patients in group B. One case of meatal stenosis and urethral stricture was recorded in each group, all of which were managed conservatively. The resultant urinary stream was single and good in 154 patients of both groups. CONCLUSIONS: Platelet-rich plasma sheet might be considered as an alternative coverage layer for distal hypospadias repair, especially in the absence of a healthy layer.

Prostatectomía convencional versus resección endoscópica de próstata monopolar en pacientes con Hiperplasia Prostática: un estudio de corte retrospectivo / Conventional prostatectomy vs. endoscopic resection of monopolar prostate in patients with Prostatic Hyperplasia: a retrospective study

La resolución quirúrgica de la hiperplasia prostática benigna se modifca conforme el acceso a las diferentes tecnologías en salud. Las complicaciones del abordaje endoscópico versus el convencional son similares. El Objetivo de este estudio fue analizar retrospectivamente los resultados de la cirugía convencional y la resección endoscópica monopolar de la hiperplasia de próstata en un hospital terciario del Ecuador. Pacientes y Métodos: Estudio retrospectivo, analítico. Fueron incluidos en el estudio 232 pacientes con diagnóstico histopatológico de hiperplasia prostática benigna atendidos en el servicio de urología del hospital Luis Vernaza en el período enero 2015 ­ diciembre 2016. Los pacientes fueron divididos en 2 subgrupos de acuerdo con el abordaje terapéutico ­ quirúrgico: prostatectomía convencional (n = 120) y resección endoscópica (n = 112). Resultados: Mediante estadística inferencial se comprobó una relación estadísticamente signifcativa entre el tipo de abordaje terapéutico con el tiempo quirúrgico (p= <0.001) y con el índice de sangrado (p= <0.001) y entre la edad y el tiempo quirúrgico (p= <0.001). Las complicaciones más importantes fueron: hemorragia inmediata (n=9) e infecciones de la herida (n=10) para la cirugía convencional y hemorragia inmediata (n=2) y sepsis (n=3) para la cirugía endoscópica. La media de tiempo quirúrgico fue 103.03 min y 75.14 min respectivamente. Conclusión: El desarrollo tecnológico ha traído la certeza de que la cirugía endoscópica tiene menores complicaciones, disminuye los tiempos quirúrgicos. Siendo una opción por considerar frente a la cirugía tradicional para la hiperplasia de próstata

Surgical resolution of benign prostatic hyperplasia is modifed as access to different health technologies. Complications of endoscopic versus conventional approach are similar. The objective of this study was to retrospectively analyze the results of conventional surgery and monopolistic endoscopic resection of prostate hyperplasia in a tertiary hospital in Ecuador. Patients and Methods: Retrospective, analytical study. 232 patients diagnosed with benign prostatic hyperplasia were included in the study in the urology service of the Luis Vernaza hospital in the period January 2015 ­ December 2016. Patients were divided into 2 subgroups according to the therapeutic­surgical approach: conventional prostatectomy (n.120) and endoscopic resection (n. 112). Results: By inferential statistics, a statistically signifcant relationship was found between the type of therapeutic approach with the surgical time (p. 0.001) and with the bleeding index (p. 0.001) and between age and surgical time (p. 0.001). The most important complications were: immediate bleeding (n-9) and wound infections (no. 10) for conventional surgery and immediate bleeding (n-2) and sepsis (no. 3) for endoscopic surgery. The surgical mean time was 103.03 min and 75.14 min respectively. Conclusions: Technological development has brought the certainty that endoscopic surgery has fewer complications, decreases surgical times. Being an option to consider against traditional prostate hyperplasia surgery

Ureterocolic fistula diagnosed on the basis of diuretic renogram and direct radionuclide cystography.

Ureterocolic fistulae are a rare phenomenon and are most commonly seen secondary to obstructive ureteric calculi. These are usually diagnosed on barium enema or intravenous urography. Most of the times, more than one investigation is needed to confirm the findings. We present a case of iatrogenically-induced ureterocolic fistula, diagnosed on renogram and direct radionuclide cystography. This case showcases the possibility of using a renogram study as a diagnostic tool for a suspected ureterocolic fistula. A renogram study also enables to asess the renal function, which is essential in deciding the management.

La colocación de catéteres doble J con anestesia local en régimen ambulatorio es un procedimiento seguro y eficiente para el manejo de distintas patologías ureterales / Office stent placement under local anesthesia is a safe and efficient procedure for the management of multiple ureteral disorders

Objetivo: Evaluar los resultados de la colocación de catéteres doble J con anestesia local para el manejo de distintas patologías ureterales. Métodos: Estudio retrospectivo de 45 cateterismos ureterales consecutivos con anestesia local desde enero de 2015 hasta julio de 2016. Se incluyeron pacientes hemodinámicamente estables con una obstrucción o fístula urinaria o para la identificación ureteral durante una cirugía abdominopélvica. Cinco minutos antes del procedimiento se instilaron 10 ml de gel-lidocaína y 50 ml de suero-lidocaína en la vejiga. Se colocaron catéteres 4,8 Fr mediante un cistoscopio flexible de 15,5 Fr y escopia. Se analizaron las características y resultados de los procedimientos. Resultados: Se realizaron 45 procedimientos (33 colocaciones, 12 recambios) en 37 pacientes, de los cuales 40 (89%) fueron exitosos. Con una edad media de 58,6 años (±17,5), se intervinieron 10 hombres (27%) y 27 mujeres (73%). Las principales indicaciones fueron litiasis (37,8%), compresiones extrínsecas del uréter (28,9%) y la localización intraoperatoria ureteral (22,2%). Los intentos infructuosos fueron debidos a la incapacidad para ascender la guía/catéter en 4 casos (8,8%) o para identificar el meato ureteral en uno (2,2%). Ocho pacientes (17,8%) presentaron alguna complicación postoperatoria (7 Clavien I, uno Clavien IIIa). Ningún procedimiento se interrumpió por dolor. El análisis estadístico no encontró ningún factor predictor de éxito. El régimen ambulatorio fue 4 veces más barato. Conclusiones: La colocación de catéteres ureterales se puede realizar de forma eficaz y segura bajo anestesia local en el gabinete de cistoscopias. Este procedimiento podría ahorrar tiempo operatorio, reducir costes y minimizar los efectos secundarios de la anestesia general

Objective: To assess the outcomes of ureteral stent placement under local anesthesia for the management of multiple ureteral disorders. Methods: Retrospective study of 45 consecutive ureteral stents placed under local anesthesia from January 2015 to July 2016. Inclusion criteria were hemodynamically stable patients with urinary obstruction, urinary fistula or for prophylactic ureteral localization during surgery. Five minutes before the procedure, 10 ml of lidocaine gel and 50 ml of lidocaine solution were instilled in the bladder. A 4.8 Fr ureteral stent was placed using a 15.5 Fr flexible cystoscope under fluoroscopic control. Characteristics of procedures and outcomes were analysed. Results: A total of 45 procedures (33 placement, 12 replacements) were attempted in 37 patients, of which 40 (89%) were successful. There were 10 male (27%) and 27 female patients (73%) with a mean age of 58.6 years (±17.5). Main indications for stent placement were stones (37.8%), extrinsic ureteral compression (28.9%) and surgery ureteral localization (22.2%). The reasons for failing to complete a procedure were the inability to pass the guidewire/stent in 4 cases (8.8%) or to identify the ureteral orifice in 1 (2.2%). Postoperative complications occurred in 8 patients (17.8%) (7 Clavien I, 1 Clavien IIIa). No procedure was prematurely terminated due to pain. Statistical analysis did not find significant successful predictors. The outpatient setting provided a fourfold cost decrease. Conclusions: Ureteral stent placement can be safely and effectively performed under local anesthesia in the office cystoscopy room. This procedure could free operating room time, reduce costs and minimize side effects of general anesthesia

[Second national census and treatment of uterine prolapse and urinary fistula].

From 1977 to 1982, under the unified deployment of the Ministry of Health, census and treatment of uterine prolapse and urinary fistula were generally carried out in various places. Compared with the first census, the organizational collaboration is more effective, professional, and play a greater role. After that, surgical treatment can be applied to a wider range, and tens of thousands of critically patients can be treated and recovered.

[An introduction of the treatment of uterine prolapse and urinary fistula from 1966 to 1976].

During the period 1966 to 1976, a large number of retained patients of uterine prolapse and urinary fistula became a problem around the maternal and child health aspects not to be ignored. All traditional Chinese and Western medical practitioners under difficult condition had been trying their best to continue to carry out the treatment. For uterine prolapse, Chinese medicine therapy included decoction therapy, acupuncture therapy, comprehensive therapy, para-uterine injection of traditional Chinese medicine preparations; whereas Western medicine treatment included hysterophore and surgery. Guangxi and other places treated urinary fistula in an organized scale, and summed up the treatment experience continuously.

Rare association of congenital penile urethrocutaneous fistula with Y-type urethral duplication.

A 24-year-old man presented with symptoms of difficulty in passage of urine, mixed with gas and stool from penoscrotal junction since birth. He had a history of surgery (posterior sagittal anorectoplasty) for imperforate anus in first week of his life. On physical examination, external meatus was adequate with small 5×5 mm fistulous opening noted at penoscrotal junction with normal anal tone and opening. On evaluation with retrograde urethrography, voiding cystourethrogram, cystoscopy and barium enema, he was found to have penile urethrocutaneous fistula of 0.5×0.5 cm with Y-type incomplete urethral duplication. Urethroanal fistula (Y-type urethral duplication) was of small size (<5 mm), so closed primarily through perineal route with interposition of ischiorectal fat. Penile urethrocutaneous fistula (4 mm) too was closed primarily and covered with tunica vaginalis flap in single sitting. It has been 6 months since surgery and the patient is fully continent and voiding well with no urinary or faecal leak.

Manometric findings in relation to functional outcomes in different types of anorectal malformations.

AIMS: To compare anorectal manometry (AM) in patients with different types of anorectal malformations (ARMs) in relation to functional outcomes. METHODS: A single-institution, cross-sectional study. After ethical approval, all patients ≥7years old treated for anterior anus (AA), perineal fistula (PF), vestibular fistula (VF), or rectourethral fistula (RUF) from 1983 onwards were invited to answer the Rintala bowel function score (BFS) questionnaire and to attend anorectal manometry (AM). Patients with mild ARMs (AA females and PF males) had been treated with minimally invasive perineal procedures. Females with VF/PF and males with RUF had undergone internal-sphincter saving sagittal repairs. RESULTS: 55 of 132 respondents (42%; median age 12 (7-29) years; 42% male) underwent AM. Patients with mild ARMs displayed good anorectal function after minimally invasive treatments. The median anal resting and squeeze pressures among patients with mild ARMs (60 cm H2O and 116 cm H2O respectively) were significantly higher than among patients with more severe ARMs (50 cm H2O, and 80cm H2O respectively; p≤0.002). The rectoanal inhibitory reflex was preserved in 100% of mild ARMs and 83% of patients with more severe malformations after IAS-saving sagittal repair. The functional outcome was poor in 4/5 patients with an absent RAIR (BFS≤11 or antegrade continence enema-dependence). Rectal sensation correlated significantly with the BFS. CONCLUSIONS: Our findings support the appropriateness of our minimally invasive approaches to the management of mild ARMs, and IAS-saving anatomical repairs for patients with more severe malformations. LEVEL OF EVIDENCE: III.

ENDOSCOPIC SHIELDING OF RECTOURETHRAL FISTULA AFTER LAPAROSCOPIC RADICAL PROSTATECTOMY; REPORT OF A CASE.

Rectourethral fistulais a relatively rare complication of radical prostatectomy but is extremely difficult to treat. We report a case with post-laparoscopic radical prostatectomy rectourethral fistula, treated with only endoscopic shielding.A 75-year-old man had undergone laparoscopic radical prostatectomy for prostate cancer, cT2cN0M0. Although there was no finding of rectal injury during the operation, pneumaturia, pyuria and diarrhea appeared at postoperative day 21 and diagnosed rectourethral fistula by colonoscopy and amidotrizoic acid enema. The fistula did not close spontaneously. Four months after the prostatectomy, we treated with endoscopic shielding by use of polyglycolic acid sheets and fibrin glue. The fistula have not recurred for 20 months after the endoscopic procedure.This method is simple and less-invasive for patients. We think it is worth trying this method before surgical management for narrow rectourethral fistula following radical prostatectomy.

Mussel adhesion-employed water-immiscible fluid bioadhesive for urinary fistula sealing.

Urinary fistulas, abnormal openings of a urinary tract organ, are serious complications and conventional management strategies are not satisfactory. For more effective and non-invasive fistula repair, fluid tissue adhesives or sealants have been suggested. However, conventional products do not provide a suitable solution due to safety problems and poor underwater adhesion under physiological conditions. Herein, we proposed a unique water-immiscible mussel protein-based bioadhesive (WIMBA) exhibiting strong underwater adhesion which was employed by two adhesion strategies of marine organisms; 3,4-dihydroxy-l-phenylalanine (DOPA)-mediated strong adhesion and water-immiscible coacervation. The developed biocompatible WIMBA successfully sealed ex vivo urinary fistulas and provided good durability and high compliance. Thus, WIMBA could be used as a promising sealant for urinary fistula management with further expansion to diverse internal body applications.

Long-term bowel functional outcomes in rectourethral fistula treated with PSARP: controlled results after 4-29 years of follow-up: a single-institution, cross-sectional study.

BACKGROUND/PURPOSE: Posterior sagittal anorectoplasty (PSARP) has become the standard surgical treatment for males rectourethral fistula (RUF) at most surgical centers worldwide. We aimed to define the long-term bowel functional outcomes following PSARP for RUF at our institution between 1983 and 2006, with comparison to age- and gender-matched controls. METHODS: Patients were invited to answer a detailed, previously validated Bowel Function Score (BFS) questionnaire by post. Respondents were matched by age and gender to three controls from the general population who had answered identical questionnaires. Case records were reviewed retrospectively for operative details. Ethical approval was obtained. Social continence was defined as soiling or fecal accidents <1/week and no requirement for changes of underwear or protective aids. RESULTS: Of 34 (79%) respondents (median age 19 (range, 4-29) years), 74% had voluntary bowel movements (VBMs), 24% were reliant on anterograde continence enema (ACE) washouts, and 1 patient had a colostomy. Impairment of bowel function was significantly higher in all aspects of fecal control among patients than controls (p<0.001). A statistically significant decline in fecal accidents and soiling was observed with age (p ≤ 0.03). Thirty-one percent of patients with VBMs had constipation managed with diet or laxatives (vs 2% of controls, p=0.0002). Of patients with VBMs followed up for > 12 years (n=20), 50% were completely continent (vs 73% of controls; p=NS). Overall, 76% of respondents were socially continent with or without artificial means in the form of ACE washouts. By BFS score, 39% had a good functional outcome, 27% had a moderate outcome, 9% had a clearly poor score and 24% were living with an ACE. CONCLUSIONS: Our results suggest that in the long-term, functional symptoms remain highly prevalent among patients treated for RUF with PSARP. However, the majority can be expected to achieve social continence, although for some this will require intervention with ACE bowel management. Approximately one third may report VBMs and complete continence.

Long-term antibiotic therapy in late onset pouch-urethral fistula after ileoanal anastomosis for ulcerative colitis may be effective and well tolerated.

A 25-year-old male patient underwent restorative proctocolectomy and ileoanal anastomosis in 1991 for refractory ulcerative colitis. In February 2001, he presented with pneumaturia, faecaluria, pelvic 'pressure' and watery diarrhoea caused by passage of urine through the anal canal. A fistula between the pouch and the membranous urethra was demonstrated by a pouchogram contrast study. In October 2002, he was started on ciprofloxacin 250 mg once daily and metronidazole 400 mg twice daily. Apart from a short break in 2003 the patient has remained on this regimen until the time of writing (now over 10 years) and has had sustained remission, excellent quality of life and no adverse effects.

Functional and manometric outcomes after a congenital pouch colon reconstruction: report of a case.

Congenital pouch colon is a form of anorectal malformation, rarely reported outside north India. Hallmarks of this malformation are a short colon containing a large distal pouch with a fistula connecting to the urinary system. Herein, the authors report the case of a Thai male neonate with a congenital pouch colon type II who was initially misdiagnosed as a common imperforate anus. As a result, urinary tract infection and metabolic acidosis developed after a colostomy. A definitive surgery consisting of a tabularized coloplasty and an abdominoperineal pull-through was performed at one month of age. After closure of the colostomy, the child experienced transient loose stool with perineal excoriation for about three months and then gradually improved. At three years of age, the patient had normal bowel movements and adequate sensation, and a contrast enema showed a normal sized neorectum. An anal endosonogram revealed good localization of the rectum. A rectal manometry showed spontaneous rectal contraction and a complete rectoanal inhibitory reflex. The present case provides evidence suggesting that preservation of the native pouch colon is not contraindicated in this type of congenital pouch colon syndrome.

Transurethral plasma vaporization of the prostate: 3-month functional outcome and complications.

UNLABELLED: Study Type - Therapy (multi-centre cohort). Level of Evidence 2b. OBJECTIVE: To evaluate the early functional outcomes of transurethral plasma vaporization of the prostate (TUVis) in a multicentre study. PATIENTS AND METHODS: A prospective multicentre observational study was conducted in eight urology departments. The inclusion criterion was benign prostatic hyperplasia (BPH) requiring surgical treatment. Patients on anti-coagulant therapy were not excluded. The TUVis procedure was performed according to a classic transurethral resection of the prostate (TURP) scheme following the manufacturer's recommendations. We evaluated subjective functional outcome using self-questionnaires (International Prostate Symptom Score [IPSS] and five-item International Index of Erectile Function [IIEF-5]) and objective criteria (prostate volume, prostate-specific antigen [PSA], uroflowmetry, post residual volume) at baseline and at 1- and 3-month follow-ups. All types of complications were systematically recorded. RESULTS: Despite 52% of patients receiving anticoagulant therapy before surgery, we reported only 3% with haemorrhagic complications, no blood transfusion, a mean catheterization time of 44 h and a mean postoperative stay of 2.9 nights. No significant change in irrigation time, catheter time or hospital stay was observed in patients with or without anticoagulant therapy. The IPSS and bother scores significantly decreased after the 3-month follow-up (57% and 59%, respectively), but the average remaining prostate volume was 29 cc and the tissue ablation rate was only 0.5 cc/min. Three major complications occurred, consisting of two urinary fistulas and one partial bladder coagulation. CONCLUSIONS: The TUVis procedure has a proven fast postoperative recovery time, good short-term functional outcome and good haemostatic efficiency. However, the tissue ablation rate was lower than expected and we encountered three major complications, the mechanisms of which remain unclear. Considering the high energy level required to create the plasma effect, the generator, cable and resectoscope must be carefully checked before each procedure.

Experiencia en el tratamiento de las fístulas rectouretrales post-prostatectomía radical / Experience in the treatment of rectourethral fistulae after radical prostatectomy

OBJETIVO: Presentar las características clínicas de las fistulas rectouretrales (FRU) tras prostatectomía radical (PR) así como nuestra experiencia en el manejo y tratamiento de las mismas.MÉTODO: Presentamos la experiencia de nuestro centro en el tratamiento de las FRU atendiendo a sus características clínicas y la presencia de factores de complejidad asociada. En todos los casos, tras la historia clínica y el examen físico el estudio se completó con uretrocistografía, enema opaco y uretrocistoscopia. Desde enero de 2000 a julio de 2010 hemos tratado 12 pacientes con FRU. La edad media fue de 64 años (rango 56-74 años). La etiología fue cirugía abierta en dos casos y cirugía laparoscópica en diez. La clínica se presentó en un plazo de 4 a 60 días.RESULTADOS: En nuestra experiencia los hallazgos endoscópicos y radiológicos tuvieron una buena correlación. Dos fístulas fueron pequeñas -menos de 5 mm- y en la vertiente uretral de la anastomosis permitiendo el tratamiento conservador el cierre espontáneo. Diez pacientes presentaron fístulas mayores, en la vertiente vesical de la anastomosis o con complejidad asociada, que requirieron para su resolución de un abordaje transesfinteriano posterior de York-Mason con buena recuperación urinaria y fecal posterior.CONCLUSIÓN: La FRU tras PR es una complicación relevante y de difícil resolución. Proponemos la cirugía reconstructiva precoz en las FRU grandes o con complejidad asociada. El cierre con abordaje transesfinteriano posterior de York-Mason ha permitido la resolución de la FRU en todos los casos(AU)

OBJECTIVES: To report the clinical charac-teristics of recto-urethral fistula (RUF) after radical prosta-tectomy (RP) as well as our experience managing them.METHODS: We present our experience in the treatment of RUF based on their clinical characteristics and the pre-sence of associated complexity factors. After medical history and physical examination, the diagnostic work up was completed in all cases with urethrograms, cystoscopy and barium enema. From January 2000 to July 2010 we treated 12 patients with RUF. Mean age was 64 years (range 56-74 years). The etiology was open sur-gery in two cases and laparoscopic surgery in ten. Clinical presentation varied from 4 to 60 days after surgery.RESULTS: In our experience, endoscopic and radiolo-gical findings were well correlated. Two fistulae were small -less than 5 mm- on the urethral side of the anasto-mosis allowing spontaneous closure after conservative treatment. Ten patients had larger fistulas on the bladder side of the anastomosis and/or were associated with com-plexity factors that required a posterior trans-sphincteric York-Mason approach for resolution, with good reco-very of urinary and fecal continence.CONCLUSION: The RUF is a significant compli-cation after RP and it is difficult to solve. We propose early recons-tructive surgery in large or complex RUF. The posterior trans-sphincteric York-Mason approach has allowed the repair in all cases(AU)

Experience in the treatment of rectourethral fistulae after radical prostatectomy.

OBJECTIVES: To report the clinical characteristics of rectourethral fistula (RUF) after radical prostatectomy (RP) as well as our experience managing them. METHODS: We present our experience in the treatment of RUF based on their clinical characteristics and the presence of associated complexity factors. After medical history and physical examination, the diagnostic work up was completed in all cases with urethrograms, cystoscopy and barium enema. From January 2000 to July 2010 we treated 12 patients with RUF. Mean age was 64 years(range 56-74 years). The etiology was open surgery in two cases and laparoscopic surgery in ten. Clinical presentation varied from 4 to 60 days after surgery. RESULTS: In our experience, endoscopic and radiological findings were well correlated. Two fistulae were small-less than 5 mm- on the urethral side of the anastomosis allowing spontaneous closure after conservative treatment. Ten patients had larger fistulas on the bladder side of the anastomosis and/or were associated with complexity factors that required a posterior transsphincteric York-Mason approach for resolution, with good recovery of urinary and fecal continence. CONCLUSION: The RUF is a significant complication after RP and it is difficult to solve. We propose early reconstructive surgery in large or complex RUF. The posterior transsphincteric York-Mason approach has allowed the repair in all cases.