Iatrogenic vesicorectal fistula: therapeutic challenges. Case reports and literature review

Abstract

Iatrogenic vesicorectal fistula (IVRF) is a serious complication of prostate and colorectal surgery. Fistula repair is a highly challenging procedure. Multiple surgical techniques for IVRF repair have been proposed, but there is as yet no consensus as to which method should be recognised as the gold standard. The aim of the paper is to present our own experience in the treatment of IVRF with reference to the most up-to-date literature reports. Different methods of IVRF treatment are discussed based on 3 patients, aged 68, 67 and 72 years, in whom vesicorectal fistula occurred after radical prostatectomy (2 cases) and rectal resection due to cancer (1 case). Before starting treatment in the urology department, all the patients underwent several unsuccessful surgical procedures performed via various operative techniques. The techniques and patient outcomes are discussed in the context of selected literature reports. Two patients with IVRF after radical prostatectomy were successfully treated by transrectal repair, while the patient with IVRF developing after the treatment of rectal cancer underwent transvesical laparoendoscopic surgery and is currently followed up. The patients’ follow-up periods are 36, 8 and 1 month, respectively. IVRF treatment is a major challenge and requires the medical team to be familiar with a variety of operative techniques. Often, multidisciplinary collaboration is essential for optimal patient management. Therapeutic failures occur regardless of the treatment used. Modern minimally invasive surgical treatments seem to occupy an important place in the therapeutic armamentarium for IVRF.