Repair Of Rectourethral Fistula Research Articles

Combined Endorectal Advancement Flap with Alloderm® Graft Repair of Radiation and Cryoablation-Induced Rectourethral Fistula

Rectourethral fistula is a potentially devastating disease for the patient and difficult management problem for the physician. We report a case of radiation and salvage cryoablation-induced rectourethral fistula for treatment of prostate cancer successfully repaired with a combined endorectal advancement flap with Alloderm graft. The surgical technique is described in detail. The patient is now one year post-repair with no evidence of recurrence.

Surgical Management of Rectourethral Fistula

To present our experience and outcomes with the challenging problem of rectourethral fistula (RUF) using the perineal approach. RUF is a rare occurrence. This was a retrospective study of patients treated from January 1999 to December 2006. Fifteen patients (aged 16 to 64 years, mean 38) were studied, and their outcomes were assessed after surgical repair. The etiology was iatrogenic in 7, congenital in 5, and traumatic in 3. All patients presented with the passage of urine through the rectum and underwent micturating cystourethrography with retrograde urethrography, followed by preliminary cystoscopy and examination under anesthesia. All patients were treated using the perineal approach and gracilis muscle flap interposition. Six patients had associated urethral pathologic features that were managed simultaneously with RUF repair. Preoperatively, bowel diversion was done at the time of the cystourethroscopy and examination under anesthesia, if not done earlier, and the definitive repair was deferred for at least 12 weeks after bowel diversion. RUF closure was successful in all the patients. Postoperatively, 2 patients had minimal urinary leakage through the perineum that resolved after repeat catheterization for 8 weeks. One stricture at the anastomotic site was managed with optical internal urethrotomy. One patient had extrusion of the gracilis flap, for which the muscle was repositioned. The results of our study have shown that RUF closure using the perineal approach with pedicled gracilis muscle interposition is associated with low morbidity and a high success rate (100%). It is the method of choice for urologists because of their familiarity with the approach and because urethral pathologic features can be corrected simultaneously. We emphasize the need for bowel diversion before attempting reconstruction.

Considerations before repair of acquired rectourethral and urethrovaginal fistulas in children

Acquired rectourethral or urethrovaginal fistula between the rectum or vaginal and lower urinary tract is an uncommon entity, which occurs as a consequence of pelvic disorder, including trauma, iatrogenic injury, inflammatory bowel disease, pelvic neoplasm or infection. But when is it appropriate to repair the fistula and what methods to be chosen? There has been no consensus on them. This study was undertaken to determine the timing of the procedure and the repair of rectourethral and urethrovaginal fistula. From 1998 to 2006, we treated 19 children with rectourethral or urethrovaginal fistula, including rectourethral fistula in 15 boys and urethrovaginal fistula in 4 girls. The mean age of the patients was 6.2 years (range, 8 months to 11.5 years). The fistula occurred after pelvic fracture in 10 patients, and after iatrogenic injury in 9 including 4 after radical operation for Hirschsprung's disease and 5 due to anorectal malformation. Preoperatively, the general and local infections were controlled thoroughly, and complications such as urethral stricture and secondary megacolon were treated at first. At least 6 months after the last procedure, all patients underwent the 1-stage York-Mason procedure (via parasacrococcygeal incision) without colostomy and suprapubic cystostomy. Intraoperatively, the entire fistulous tract was excised completely. Infection and partial dehiscence of the wound occurred in 2 patients respectively. All fistulae were closed successfully without fecal incontinence or postoperative anal stricture. No patient suffered from urinary incontinence after fistula repair. The scars around the fistula were removed because they would shrink and lead to subsequent urethral occlusion or stricture. The timing of operation for acquired rectourethral or urethrovaginal fistula is appropriate at least 6 months after the last procedure. The 1-stage York-Mason procedure for the repair of the fistula is feasible and effective.

Laparoscopic assisted endorectal pull-through with posterior sagittal approach to the repair of postoperative rectourethral and rectovaginal fistula

Rectourethral or rectovaginal fistula is a troublesome complication after anorectal surgery. The pelvic and perineal dissection may be difficult because of severe fibrosis adhesion around the fistula. The authors applied a novel technique: a combined laparoscopic assisted abdominal and posterior sagittal approach (PSA) to perform the redo surgery. Three boys and two girls (3-13 years old): case 1 had rectovaginal fistula after rectal dialation and modified Swenson's procedure; case 2 had rectovestibular fistula after twice perineal anorectoplasty; case 3 had rectourethral fistula after twice anorectoplasty; case 4 was imperforate anus with Hirschsprung's disease and rectourethral fistula that had been misdiagnosed; case 5 had rectourethral fistula after abdominoperineoanoplasty and Mollard procedure and posterior sagittal anorectoplasty. Laparoscopic assisted abdominal dissection was done first to mobilize the colon as far as the mid pelvis, and the normal colon was marked with a suture. The lower pelvic dissection was performed through the posterior sagittal route, the proximal rectum was mobilized and servered, the distal rectum was left undisected, endorectal mucosectomy with electric ablation was performed, then the fistula was closed from inside the rectum, and the stump of the colon was pulled through the rectum, the stump and the dentate line were anastomosed extraanally. Colostomy was done in case 2 and case 5. The postoperative follow-up showed no recurrent fistula, and all patients had attained normal voluntary bowel actions, but one child had infrequent minor soiling. Laparoscopic assisted endorectal pull-through of the intact colon can offer precise dissection, minimal abdominal injure, and spare troublesome mobilization of the fistula, and can prevent the recurrent of fistula. Posterior sagittal approach provides a direct repair of the fistula and anastomosis.

29: Evaluation of Urinary Outcome after Repair of Rectourethral Fistula in Patients Previously Treated for Prostate Cancer

You have accessJournal of UrologyModerated Poster 2, Saturday, May 19, 2007, 1:00 - 3:00 pm1 Apr 200729: Evaluation of Urinary Outcome after Repair of Rectourethral Fistula in Patients Previously Treated for Prostate Cancer Mostafa M. Elmissiry, Gamal M. Ghoniem, Eric G. Weiss, Carolyn F. Langford, Hassan A. Abdelwahab, Dan E. Ruiz, and Steven D. Wexner Mostafa M. ElmissiryMostafa M. Elmissiry More articles by this author , Gamal M. GhoniemGamal M. Ghoniem More articles by this author , Eric G. WeissEric G. Weiss More articles by this author , Carolyn F. LangfordCarolyn F. Langford More articles by this author , Hassan A. AbdelwahabHassan A. Abdelwahab More articles by this author , Dan E. RuizDan E. Ruiz More articles by this author , and Steven D. WexnerSteven D. Wexner More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)30294-5AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "29: Evaluation of Urinary Outcome after Repair of Rectourethral Fistula in Patients Previously Treated for Prostate Cancer." The Journal of Urology, 177(4S), p. 11 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 177Issue 4SApril 2007Page: 11 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Mostafa M. Elmissiry More articles by this author Gamal M. Ghoniem More articles by this author Eric G. Weiss More articles by this author Carolyn F. Langford More articles by this author Hassan A. Abdelwahab More articles by this author Dan E. Ruiz More articles by this author Steven D. Wexner More articles by this author Expand All Advertisement Loading ...

Transanal endoscopic microsurgical repair of iatrogenic recto-urethral fistula

Recto-urethral fistula formation following radical prostatectomy is an uncommon but potentially devastating event. Traditional surgery for such fistulae is technically demanding, jeopardizes continence and usually necessitates a diverting colostomy. We present the case of an iatrogenic fistula treated by a transanal endoscopic microsurgical approach, without recourse to a stoma. A 71-year-old man had recently undergone a radical prostatectomy, complicated by significant intra-operative haemorrhage. He subsequently developed a recto-urethral fistula, confirmed clinically and endoscopically. Due to his bleeding diathesis, he was considered for, and underwent, a transanal endoscopic microsurgical (TEMS) repair. TEMS is a safe and reliable minimally-invasive surgical technique for the treatment of this difficult condition.

Transsphincteric repair of rectourethral fistulas following laparoscopic radical prostatectomy

Rectourethral fistula is a serious complication following laparoscopic radical prostatectomy. We report our experience with a transsphincteric approach in the repair of this uncommon complication. The rectourethral fistula was repaired in a three-stage procedure comprising fecal diversion, transsphincteric repair of the fistula and, finally, closure of the stoma. Two patients with rectourethral fistulas underwent this procedure and the postoperative course was uneventful. In conclusion, a transsphincteric approach in the repair of rectourethral fistula by a three-stage procedure is safe and may be the treatment of choice.

Endorectal pull-through with posterior sagittal approach to the repair of postoperative rectourethral and rectovaginal fistula

Background/purpose: Rectourethral (RUF) or rectovaginal fistula (RVF) is a troublesome complication after anorectal surgery because of dense adhesions around the fistula. The authors applied a new technique for the redo surgery. Methods: Case 1 is Hirschsprung’s disease in a 1-year-old boy who underwent modified Duhamel’s procedure and had RUF. Case 2 is rectovestibular fistula in an 11-year-old girl who had anterior sagittal anorectoplasty complicated by RVF. Case 3 is multiple urogenital anomalies including rectovesical fistula in a 4-year-old boy in whom transvesical repair was unsuccessful. The colon was mobilized as far as possible at laparotomy. The rectum was opened via a posterior sagittal approach leaving 1 cm of the anal canal. Extended endorectal mucosectomy was performed to the dentate line, and the fistula was closed from inside of the rectum. The remaining mucosal cuff was everted out of the anus and the intact colon was pulled through the rectum and anastomosed to the cuff extraanally. Results: The postoperative contrast enema showed no recurrent fistula, and defecation was not impaired. Conclusions: Endorectal pull-through of the intact colon can spare troublesome mobilization of the fistula and can prevent the recurrence of fistula. Rectal incision via a posterior sagittal approach provides a direct view of the fistula.

30 Years of Experience with York-mason Repair of Recto-Urinary Fistulas

Recto-urinary fistula formation is a rare occurrence, usually following surgery or another intervention for prostatic disease. Spontaneous closure is rarely successful and reconstructive procedures are usually performed. We report our experience in the last 30 years with modified York-Mason repair. To our knowledge our series of 24 patients is the largest reported using this approach. We retrospectively reviewed the medical records of all patients who underwent acquired rectourethral or rectovesical fistula repair at our institution. A total of 24 patients underwent York-Mason recto-urinary fistula repair, 18 fistulas occurred secondary to prostatic surgery and 11 patients underwent 1-stage repair without preoperative urinary or fecal diversion. Overall 22 of the 24 fistulas were repaired successfully using the York-Mason approach. One patient required a repeat York-Mason procedure and another required a perineal incision to correct recurrence. All except 1 fistula were eventually surgically corrected. No fecal incontinence or anal stenosis developed. The fistula involved the bladder and urethra in 11 and 13 cases, respectively. Procedure time was less than 2 hours. Blood loss was 50 to 400 cc. No transfusions were required. York-Mason repair of recto-urinary fistula is an excellent approach to a rare and often confounding surgical complication. It provides nice exposure through unscarred planes and allows adequate closure. The success rate is excellent compared with that of other reported techniques. Postoperative recovery is rapid with minimal morbidity.

Dartos flap interposition in the surgical repair of rectourethral fistulas.

Multilayer closures are important techniques in urethral fistula repair. We report our experience with dartos flap interposition in the repair of rectourethral fistula. A tip of a V-shaped scrotal skin flap is mobilized and de-epithelialized to develop a dartos flap. Two patients with a rectourethral fistula underwent fistula closure covered with this dartos flap. The surgical repair was successful in both cases and neither patient showed any late complication. A scrotal dartos flap is well vascularized and easy to mobilize. We believe this technique is helpful in preventing postoperative complications following complex posterior urethral surgery.

Posterior sagittal approach for repair of rectourethral fistula occurring after perineal surgery for imperforated anus at birth

Purpose: Posterior sagittal approach was used for the repair of 11 cases of rectourethral fistula between 1992 and 1998. Methods: All these patients had rectourethral fistula as a result of perineal procedure performed for imperforate anus at the time of birth. In addition to the fistula repair, an associated anorectal stenosis (3 cases) and urethral stricture (1 case) also were corrected with this approach. All the patients underwent surgery under cover of a protective colostomy. Results: Successful repair was achieved in all patients, and the follow-up period ranged from 10 months to 7 years. As far as bladder and bowel control, urinary control was normal in all 11 patients, whereas bowel control was normal in 10 cases. One patient who had severe scarring of anal sphincters caused by infection in the previous surgery still suffers occasional perianal soiling after 18 months of follow-up. Conclusions: Posterior sagittal approach not only gives adequate exposure but also suits the basic principles of fistula repair, namely, completely separating the rectum from urethra and leaving normal rectal wall behind the urethral sutures thus eliminating the possibility of recurrence. In addition to fistula repair, one can also correct associated problems like anorectal stenosis or urethral stricture, and a mislocated rectum can be relocated within the sphincter complex. J Pediatr Surg 35:1155-1160. Copyright © 2000 by W.B. Saunders Company.

Massive Hemorrhage from the Diverted Colon as a Complication of Rectourethral Fistula Repair: Case Report and Review

A case of congenital rectourethral fistula with massive hemorrhage from the diverted colon during the postoperative period is reported. The entity of diversion colitis is highly under recognized. The pathology and management are briefly discussed.

The Kraske Approach to the Repair of Recurrent Rectourethral Fistula

Rectourethral fistula is an uncommon surgical complication that may follow correction of anorectal anomalies. Previously described operations to repair the fistula have a high incidence of failure. Operative success is measured by achieving permanent separation of rectum from urethra, preventing urethral injury, and preserving urinary and fecal continence. Two patients with recurrent rectourethral fistula were repaired successfully. The operation described is performed through a posterior transsphincteric Kraske approach with direct repair of the fistula and resection of the fistula containing anorectal tube.

The Kraske approach to the repair of recurrent rectourethral fistula

Rectourethral fistula is an uncommon surgical complication that may follow correction of anorectal anomalies. Previously described operations to repair the fistula have a high incidence of failure. Operative success is measured by achieving permanent separation of rectum from urethra, preventing urethral injury, and preserving urinary and fecal continence. Two patients with recurrent rectourethral fistula were repaired successfully. The operation described is performed through a posterior transsphincteric Kraske approach with direct repair of the fistula and resection of the fistula containing anorectal tube.

A Technique for the Repair of Recto-Urethral Fistula

A Technique for the Repair of Recto-Urethral Fistula