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.

[New recommendations for prostate cancer screening with PSA]. / Nuevas recomendaciones en el screening de cáncer de próstata mediante PSA.

Prostate cancer is the most frequently diagnosed cancer in men and the second cause of death in those worldwide. The fact that is a tumor with a long latency period has led to a confusion in the convenience of its diagnosis and treatment in patients at an early stage. Classically, European and American societies have not recommended prostate cancer screening with PSA, allowing physicians take this decision. In 2012, after many years full of controversy, the American organization United States Preventive Task Force recommended to abandon its use. The results of these statements carried an increase in the incidence of the metastatic prostate cancer and, therefore, a rise in its mortality. In 2018, after these consequences, the European Association of Urology released new recommendations in favor of screening based on PSA for the first time. In 2019, guidelines were updated with no changes in its recommendations.