237 RECONSTRUCTION OF COMPLEX RECTOURETHRAL FISTULAS WITH THE INTENT OF PRESERVING ORTHOTOPIC BOWEL AND BLADDER FUNCTION

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery III1 Apr 2012237 RECONSTRUCTION OF COMPLEX RECTOURETHRAL FISTULAS WITH THE INTENT OF PRESERVING ORTHOTOPIC BOWEL AND BLADDER FUNCTION Ty Higuchi, Yuka Yamaguchi, Ryan Mori, Hadley Wood, and Kenneth Angermeier Ty HiguchiTy Higuchi Cleveland, OH More articles by this author , Yuka YamaguchiYuka Yamaguchi Cleveland, OH More articles by this author , Ryan MoriRyan Mori Cleveland, OH More articles by this author , Hadley WoodHadley Wood Cleveland, OH More articles by this author , and Kenneth AngermeierKenneth Angermeier Cleveland, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.292AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Complex rectourethral fistulas (RUF) present a daunting challenge for the reconstructive urologist due to poor tissue quality, cavitation, and tissue fixation with loss of planes of dissection. In patients wishing to avoid urinary and fecal diversion, surgical repair requires careful preoperative evaluation, tissue interposition and possibly formal urethral reconstruction. We reviewed our experience with reconstruction of complex RUFs. METHODS We retrospectively reviewed patients undergoing reconstruction of complex RUFs with the intent of preserving orthotopic bowel and bladder function from 2004 to 2011. RUFs were related to one or more ablative therapies for prostate cancer (XRT, brachy or cryotherapy), surgical complication (salvage prostatectomy, large fistula) or previous failed repair(s). All patients underwent fecal diversion prior to surgery. Transperineal RUF repair was performed with urethral fistula closure or urethral reconstruction, primary rectal repair and gracilis muscle interposition. RESULTS Thirty patients were identified and the etiology of the RUF was 13 ablative therapy, 7 combination ablative therapy, 3 complex surgical and 7 previously failed repair(s). Median age was 64 years (range 36-75) at the time of RUF repair. Primary closure of the urethral defect was performed in 50% (15/30), buccal mucosal patch in 23% (7/30) and excision of the fistula and unhealthy tissue with primary urethral anastomosis in 27% (8/30). At a median follow-up of 10.4 months (range 1.3 - 44.6), 93% (28/30) of the patients achieved closure with 1 repair. Both failures were combined ablative fistulas. One recurred 1 mo after colostomy closure and had a successful second repair of the urethra with permanent colostomy. The second developed 1 mo after ileostomy closure and has closed with repeat fecal diversion. Overall, bowel diversion was closed in 80% (24/30) of patients with 3 awaiting closure, 1 not a candidate due to ongoing colitis and the two failed repairs. In patients who have completed their reconstruction, 2 patients required DVIU for recurrent stricture, 1 had a suprapubic tube for recalcitrant stricture, 5 had AUS of which 1 had multiple infections and eventually was managed with bladder neck closure and continent catheterizable stoma. CONCLUSIONS Complex RUFs can be closed with a high success rate and restoration of orthotopic bowel and bladder function in the majority of patients. Long term studies are required to determine the durability of these repairs. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e97-e98 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ty Higuchi Cleveland, OH More articles by this author Yuka Yamaguchi Cleveland, OH More articles by this author Ryan Mori Cleveland, OH More articles by this author Hadley Wood Cleveland, OH More articles by this author Kenneth Angermeier Cleveland, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...