Rectovesical and ectourethral fistula: five case reports and review of the literature

Abstract

Objectives To reduce the incidence of rectal injuries and rectovesical/ectourethral fistula and improve the diagnosis and management of rectovesical/ectourethral fistula.Methods According to the reports in the literatures,the diagnosis and management of rectovesical/ectourethral fistula in 5 cases were analyzed retrospectively.Results Among 88 patients who underwent laparoscopic radical prostatectomy,three cases developed rectovesical fistula after operation which was not found by intraoperative digital rectal examination.At 1217 days postoperatively,rectovesical fistula occurred and was cured by conservative approachs such as catheterization and nutritional support without surgical intervention including colostomy and surgical repair.One case developed rectovesical fistula because of pelvic tumor.After receiving ureterocutaneostomy and descending colon exteriorization the general condition of the patient improved and the temperature dropped.A case of 18-month ectourethral fistula after pelvic stromal tumor operation was cured by perineal repair.Conclusions During the operation,several factors such as radiotherapy,operation history,pelvic hematoma,infection and neoadjuvant therapy may lead to difficult dissection of prostate,especially the apex of the prostate and recto-urethralis and cause rectal injuries.Meanwhile,reducing the electrical heat injury of ultrasound knife and monopolar electrocoagulation to rectal anterior wall and avoiding postoperative pelvic infection may reduce the incidence of rectal injuries.When rectovesical/ectourethral fistula occurred,conservative management should be first considered,such as catheterization and nutritional support.If the fistula still did not close after three months or fecal stream still existed,colostomy should be performed.Furthermore,if the fistula did not close three months after colostomy,surgical repair should be considered.And surgical repair should be performed according to general condition of patients and the location of orificium fistulae.Surgical repair is less effective to treat the fistula caused by tumor than urinary/fecal diversion. Key words: Urinary Bladder; Rectal Fistula; Urethral Diseases