PD14-02 RECTOURETHRAL FISTULA REPAIR: EXPERIENCE OF VARIOUS APPROACHES OVER 30 YEARS

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Urethral Reconstruction (including Stricture) II1 Apr 2015PD14-02 RECTOURETHRAL FISTULA REPAIR: EXPERIENCE OF VARIOUS APPROACHES OVER 30 YEARS Christopher Zappavigna and Sender Herschorn Christopher ZappavignaChristopher Zappavigna More articles by this author and Sender HerschornSender Herschorn More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1331AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Rectourethral fistulae (RUF) represent a rare complication following extirpative or ablative treatment of the prostate. Presenting symptoms include fecaluria, pneumaturia, rectal urinary leakage and recurrent UTIs. Most cases do not resolve with conservative management and will require surgical closure. Given the rare incidence, experience is limited to individual case series. We report here a single surgeon experience over 30 years. METHODS We reviewed the records of all patients treated at our institution for RUF over the last 30 years. Patient demographics, fistula characteristics, treatment and outcomes were recorded in our database using software Visual Dbase v10. Most were referred from outside institutions. The surgical approach used for each patient was based on individual patient and fistula characteristics; a diverting colostomy or ileostomy was performed in all patients with symptoms or signs of infection, or as felt necessary. Evaluation included a detailed history, including review of previous operative reports, physical examination and imaging tests such as cystoscopy, cystogram and occasionally examination under anesthesia to delineate the fistula. RESULTS Mean and median age of patients at time of repair was 64.5 years (range 46-86). Etiology of the fistula was varied, with radical prostatectomy the most common etiology. Six patients had previous radiation therapy. Six patients had had a prior, unsuccessful attempt at surgical repair. The most common approach of the previous repair was posterior, however, various approaches for operative repair were used, including the transsagittal, transspinchteric (York-Mason) approach in 11 patients, transanal in 3 patients, transperineal in 3 patients (one with gracilis muscle interposition). Of the patients with a transabdominal repair, 5 underwent a radical prostatectomy and rectal repair. Six patients had previous failed repairs: 4 had a transperineal approach, 1 prostatectomy and rectal closure and 1 injection. Mean follow-up was 31 months. Initial repair at our institution was successful in all but one patient. Stress urinary incontinence was the most common complication with 15 patients experiencing this post operatively (8 severe). One patient underwent insertion of artificial urinary sphincter and one a male sling. CONCLUSIONS RUF remains a complex problem which often requires surgical correction. Proper evaluation and selection of patients, as well as management by an experienced surgeon is key to better outcomes in this rare, but significant disease. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e319 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher Zappavigna More articles by this author Sender Herschorn More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...