Transanal Endoscopic Microsurgery for Correction of Rectourethral Fistulae

Abstract

Rectourethral fistula is a rare complication of radical prostatectomy. Transanal endoscopic microsurgery (TEM) is a minimally invasive technique available for its surgical correction, although currently, TEM is used more commonly for excision of adenomas and stage T(1) carcinomas of the rectum. We report two patients with rectourethral fistulae after laparoscopic radical prostatectomy in whom TEM was used for closure. The surgical procedure included microscopic full-thickness excision of the rectal wall around the fistula with a 1-cm margin and endoscopic suturing of the defect in the urethral and rectal walls. In one case, the rectourethral fistula was closed using TEM. In the other patient, the procedure, performed after failure of a graciloplasty, was difficult because of extensive scar tissue, and the fistula persisted. The TEM procedure is a minimally invasive technique that may be considered for surgical repair of rectourethral fistulae.