V1566 THE YORK-MASON TECHNIQUE FOR REPAIR OF RECTO-URINARY FISTULAS AFTER RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyInfertility, Infection, Erectile Dysfunction & Trauma1 Apr 2011V1566 THE YORK-MASON TECHNIQUE FOR REPAIR OF RECTO-URINARY FISTULAS AFTER RADICAL PROSTATECTOMY Enrique Rijo, Jose A. Lorente, Oscar Bielsa, Miguel Pera, Albert Frances, and Octavio Arango Enrique RijoEnrique Rijo Barcelona, Spain More articles by this author , Jose A. LorenteJose A. Lorente Barcelona, Spain More articles by this author , Oscar BielsaOscar Bielsa Barcelona, Spain More articles by this author , Miguel PeraMiguel Pera Barcelona, Spain More articles by this author , Albert FrancesAlbert Frances Barcelona, Spain More articles by this author , and Octavio ArangoOctavio Arango Barcelona, Spain More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1589AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The recto-urinary fistula is a rare complication following treatment for prostate cancer (surgery, ablative and ionizing therapies) or pelvic traumas. The reported incidence after radical prostatectomy is 0.4–1.8%. Spontaneous resolution rarely occurs and many reconstructive procedures have been proposed. Successful repair is often difficult. We report our experience with the trans-sphincteric-transrectal approach (York-Mason Technique) for rectourinary fistula repair after radical prostatectomy. METHODS Between September 2002 and July 2010, a repair of rectourinary fistulas with the posterior York-Mason approach was performed on 12 patients in our institution. The fistula repair was carried out between 5 and 10 months months after diagnosis. All patients had a pre-operative voiding cystogram, and cystoscopy which documented the recto-urinay fistula. A loop ileostomy was performed on 6 patients at the time of definitive surgical repair, whereas an initial fecal diversion with a sigmoid loop colostomy was performed in 4 other cases. Here follows the details of one such case. Case report: A 56-year-old male patient presented with adenocarcinoma of the prostate gland pT1cNxMx stage, Gleason score 7 (3+4). The patient had undergone a non-nerve sparing laparoscopic transperitoneal radical prostatectomy. A rectal injury occurred during surgery and was repaired primarily. Eight days postoperatively, the patient experienced fecaluria and pneumaturia. Radiographic and endoscopic evaluation supported the diagnosis of a recto-vesical-fistula and localized the defect. Initial management included an indwelling urethral catheter without fecal diversion. The fistula failed to close and the patient was referred to our center for corrective surgery. At five months, a York-Mason repair of the fistula was performed. Initial fecal diversion with a sigmoid loop colostomy was performed at the time of surgical repair. This video describes the York-Mason repair surgical technique step-by-step. RESULTS Successful fistula closure was achieved in all cases with complete fecal continence. No recurrence was observed after a mean follow-up of 46 (4–90) months. CONCLUSIONS The York Mason Technique provides easy identification of recto-urinary fistulas and excellent surgical exposure with minimal postoperative morbidity and no impairment of continence. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e628 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Enrique Rijo Barcelona, Spain More articles by this author Jose A. Lorente Barcelona, Spain More articles by this author Oscar Bielsa Barcelona, Spain More articles by this author Miguel Pera Barcelona, Spain More articles by this author Albert Frances Barcelona, Spain More articles by this author Octavio Arango Barcelona, Spain More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...