MP53-18 WHAT IS THE CLINICAL SIGNIFICANCE OF A RADIOLOGICAL LEAK AFTER URORECTAL FISTULA (URF) REPAIR?

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II (MP53)1 Sep 2021MP53-18 WHAT IS THE CLINICAL SIGNIFICANCE OF A RADIOLOGICAL LEAK AFTER URORECTAL FISTULA (URF) REPAIR? Simon Bugeja, Anastasia Frost, Stella Ivaz, Nikki Jeffrey, Mariya Dragova, Angelica Lomiteng, Daniela E. Andrich, and Anthony R. Mundy Simon BugejaSimon Bugeja More articles by this author , Anastasia FrostAnastasia Frost More articles by this author , Stella IvazStella Ivaz More articles by this author , Nikki JeffreyNikki Jeffrey More articles by this author , Mariya DragovaMariya Dragova More articles by this author , Angelica LomitengAngelica Lomiteng More articles by this author , Daniela E. AndrichDaniela E. Andrich More articles by this author , and Anthony R. MundyAnthony R. Mundy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002083.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recurrence after URF repair usually occurs from the urinary side of the fistula. This study evaluates the clinical significance of a radiological leak on pericatheter urethrogram after URF repair as a predictor of success or failure of the surgery. METHODS: 138 URF repairs, mostly resulting as a complication following the treatment of prostate or rectal cancer, were performed between January 2006 and June 2020 in a single reconstructive urology unit. Data were available on 113 of these for analysis. RESULTS: 71 cases (63%) were performed via a transperineal (TP) approach with a gracilis interposition flap in 27 (38%). 42 cases (37%) required additional abdominal exposure. 60 cases (54%) were performed in patients who had undergone radiotherapy, HIFU or cryotherapy. 20 (18%) were redo procedures. All patients had a pericatheter urethrogram at a mean of 31 days (range 21-70d) post-op. 43 (38%) patients had no radiological leak and the catheter removed at the time. 30 (27%) patients demonstrated leakage of contrast directly into the rectum or onto the perineum. Only 4 of these healed by conservative management. All 4 had a TP approach, were unirradiated and fairly uncomplicated URF. The other 26 developed recurrent fistulation. In a further 40 patients (35%), contrast leakage into a blind-ending track (n=24) or contained cavity (n=16) was observed. The catheter was left in situ and a second urethrogram performed on average 24 days later (range 7-93d). In 19, the radiological leak was no longer evident and the catheter removed. The remaining 21 had a third urethrogram at a mean of 32 days later (range 13-91) and in 14 the leak had resolved. The remaining 7 had their catheters eventually removed at an average of 111 days post-op (range 88-180d). Of all 40 patients with a contained leak on initial urethrogram managed conservatively, only 3 showed clinical evidence of fistula recurrence after catheter removal. These were all after abdomino-perineal repairs in irradiated patients. CONCLUSIONS: Radiological evidence of persistent fistula on the first post-operative urethrogram after URF repair is a likely predictor of failure. However, presence of a leak from the urinary side into a contained cavity or a blind-ending track is a relatively common occurence. In most instances this can be managed successfully conservatively without compromising the final outcome. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e945-e946 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Simon Bugeja More articles by this author Anastasia Frost More articles by this author Stella Ivaz More articles by this author Nikki Jeffrey More articles by this author Mariya Dragova More articles by this author Angelica Lomiteng More articles by this author Daniela E. Andrich More articles by this author Anthony R. Mundy More articles by this author Expand All Advertisement Loading ...