You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II1 Apr 2018PD43-07 MANAGEMENT OF URINARY/PERINEAL FISTULAE COMPLICATING THE MODERN TREATMENT OF RECTAL CANCER Simon Bugeja, Stella Ivaz, Anastasia Frost, Mariya Dragova, Daniela E. Andrich, and Anthony R. Mundy Simon BugejaSimon Bugeja More articles by this author , Stella IvazStella Ivaz More articles by this author , Anastasia FrostAnastasia Frost More articles by this author , Mariya DragovaMariya Dragova 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/10.1016/j.juro.2018.02.2119AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The introduction of neo-adjuvant chemo-radiation as standard in addition to surgery for the treatment of locally invasive carcinoma of the rectum has changed the nature and complexity of the urological complications that may arise from the surgery alone. We evaluate the options available in dealing with post-rectal cancer treatment fistulae, as distinct from post-prostate cancer treatment fistulae and identify the difficulties in managing these patients, particularly in the presence of concomitant radiotherapy-related damage to adjacent structures. The results of reconstructive surgery are assessed as an alternative to double diversion. METHODS 32 patients with a mean age of 62 years (range 49 – 80 years) were treated for urinary and/or perineal fistulae following the treatment of rectal cancer in a single unit. All had chemo-radiotherapy followed by surgery. 26 presented with a leak and fistulation while the remaining 6 had a contained leak. Of the 26 with fistulation, 20 were after abdomino-perineal resection and 6 after low anterior resection. All were evaluated by MRI which showed a fistulous track, usually arising from the prostatic urethra, with variable degrees of cavitation into the presacral space in all. RESULTS 26 of 32 patients (81.3%) were treated surgically while the remaining 6 with less troublesome symptoms were managed conservatively. 1 subsequently required surgery for an infected, discharging cavity. He and another 23 of the 26 managed surgically underwent reconstruction while the other 3 had a single diversion with repair of the other system.Of the 24 patients undergoing reconstruction, 12 were approached transperineally using a gracilis flap in all. 8 were successful while the 4 failures were all subsequently repaired successfully transabdominally. The other 12 underwent an abdominal or abdomino-perineal approach from the outset, 11 of which were successful, leaving only one patient with a double diversion. 10 of these 12 required an augmentation or substitution cystoplasty to enable closure of the fistula and/or deal with a small capacity bladder. 2 patients went on to have an artificial urinary sphincter at a later stage. The overall fistula closure rate (primary or after revision) was 95.8% (23 of 24). CONCLUSIONS Management of fistulae following the modern treatment of rectal cancer presents another level of complexity compared to post-prostate cancer treatment fistulae due to the presence of radiotherapy change and cavitation into the presacral space to some degree or another in all. Nevertheless most patients are salvageable and do not need double diversion. Minimally symptomatic ones may be managed conservatively. Reconstruction is a major undertaking with a protracted recovery, usually best done abdomino-perineally, commonly requires a cystoplasty and may need subsequent AUS implantation. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e879 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Simon Bugeja More articles by this author Stella Ivaz More articles by this author Anastasia Frost More articles by this author Mariya Dragova More articles by this author Daniela E. Andrich More articles by this author Anthony R. Mundy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...