Abstract
Objective
To report our experience and outcomes in minimally invasive management of rectourethral
fistula (RUF).
Methods
From 2004 to 2021, 15 patients who underwent minimally invasive RUF repair by a single
surgeon at 2 international institutions were retrospectively reviewed. Baseline demographic
characteristics, perioperative, and postoperative data were collected. Complications
were reported using the modified Clavien-Dindo Classification System and the European
Association of Urology Complication Panel Assesment and Recommendations. Success was
defined as complete resolution of fistula-related symptoms at 12-month follow-up along
with confirmation of fistula closure by imaging or cystoscopy. Categorical variables
were presented as frequencies and percentages whereas continuous variables were reported
as median and quartiles.
Results
Fifteen male patients with a median age of 71 (64-79.2) years were treated. Four cases
(26.6%) occurred postsurgery, 8 cases (53.3%) occurred after energy treatments, and
3 cases (20%) after surgery combined with an energy treatment modality. A robotic
and laparoscopic approach was performed in 9 (60%) and 6 (40%) patients, respectively.
No intraoperative complications were reported. Median operative time was 264 (217.5-341)
minutes, estimated blood loss was 175 (137.5-200) mL, and the length of hospital stay
was 4 days. Nine postoperative complications were reported. All patients were followed-up
for 12 months with no recurrence reported. All patients reached our criteria for successful
RUF repair.
Conclusions
Minimally invasive surgery could represent an efficient way to manage RUF in selected
patients. More studies and treatment standardization are needed to assess the role
of minimally invasive surgery in the management of RUF.
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References
- Minimally invasive management of urological fistulas.Curr Opin Urol. 2015; 25: 136-142
- Rectourethral fistula after high-intensity focused ultrasound therapy for prostate cancer and its surgical management.Urology. 2011; 77: 999-1004
- Prostatourethral-rectal fistula after prostate brachytherapy: incidence and risk factors.Cancer. 2000; 89: 2085-2091
- Rectourethral fistula: operative technique and outcomes.Curr Bladder Dysfunct Rep. 2019; 14: 151-156
- Neoadjuvant chemoradiation and rectal cancer.J Clin Pathol. 2019; 72: 97-101
- Management of acquired rectourethral fistulas in adults.Asian J Urol. 2018; 5: 149-154
- Acquired rectourethral fistulas in adults: a systematic review of surgical repair techniques and outcomes.Dis Colon Rectum. 2013; 56: 374-383
- Management of radiotherapy induced rectourethral fistula.J Urol. 2006; 175: 1382-1388
- Posterior urethral complications of the treatment of prostate cancer: posterior urethral complications of the treatment of prostate cancer.BJU Int. 2012; 110: 304-325
- Rectourethral fistula management.Curr Urol Rep. 2016; 17: 22
- High-intensity focused ultrasound for treating prostate cancer.BJU Int. 2007; 99: 28-32
- Five-year retrospective, multi-institutional pooled analysis of cancer-related outcomes after cryosurgical ablation of the prostate.Urology. 2001; 57: 518-523
- Rectal injury occurring at radical retropubic prostatectomy for prostate cancer: etiology and treatment.Urology. 1993; 42: 401-405
- Surgical management of rectourethral fistula.Urology. 2008; 71: 267-271
- Laparoscopic repair of rectourethral fistulas after prostate surgery.Urology. 2007; 70: 515-518
- Incidence, clinical symptoms and management of rectourethral fistulas after radical prostatectomy.J Urol. 2010; 183: 608-612
- Conservative management of urorectal fistulae.Urology. 2013; 81: 1352-1356
- Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg. 2004; 240: 205-213
- Reporting and grading of complications after urologic surgical procedures: an ad hoc EAU guidelines panel assessment and recommendations.Eur Urol. 2012; 61: 341-349
- Best practice statement on urologic procedures and antimicrobial prophylaxis.J Urol. 2020; 203: 351-356
- A modified instrument and method for laparoscopy.Am J Obstet Gynecol. 1971; 110: 886-887
- Surgical principles of omentoplasty in urology.BJU Int. 2007; 99: 1191-1196
- Laparoscopic radical prostatectomy: initial experience and preliminary assessment after 65 operations.Prostate. 1999; 39: 71-75
- Vesicovaginal fistula repair with rectus abdominus myofascial interposition flap.Urology. 2008; 71: 1119-1123
- Technique for laparoscopic running urethrovesical anastomosis: the single knot method.Urology. 2003; 61: 699-702
- Reconstructing the lower urinary tract: the Mitrofanoff principle.Indian J Urol. 2013; 29: 316
- Urinary fistulas following external radiation or permanent brachytherapy for the treatment of prostate cancer.J Urol. 2005; 173: 1953-1957
- Short-term outcomes of the surgical management of acquired rectourethral fistulas: does technique matter?.Res Rep Urol. 2013; 5: 47-51
- Techniques of Robotic Urinary Tract Reconstruction: A Complete Approach.Springer International Publishing, Cham2022: 365-374 (Available at:) (Accessed March 2, 2022)
- Management of surgical and radiation induced rectourethral fistulas with an interposition muscle flap and selective buccal mucosal onlay graft.J Urol. 2010; 184: 2400-2404
Article info
Publication history
Published online: August 20, 2022
Accepted:
May 22,
2022
Received:
January 27,
2022
Footnotes
Financial Disclosure: The authors declare no conflicts of interest.
Funding Support: There was no source of funding.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
