Repair Of Rectovesical Fistula Research Articles

Robotic Simultaneous Repair of Rectovesical Fistula With Vesicourethral Anastomotic Stricture after Radical Prostatectomy: Step-by-Step Technique and Outcomes

ObjectiveTo report our experience and outcomes using a novel robotic technique for the simultaneous repair of rectovesical fistula (RVF) with vesicourethral anastomotic stricture (VUAS) after radical prostatectomy (RP). MethodsBetween 2019 and 2021, four consecutive patients who underwent robotic-assisted simultaneous repair of RVF with concurrent VUAS after RP were retrospectively reviewed. Baseline characteristics and perioperative outcomes were examined and reported. Complications were graded using the modified Clavien-Dindo classification system and the European Association of Urology Complications Panel Assessment and Recommendations. ResultsFour cases with a median age of 68.5 (63.3-72.3) years were treated. Interposition omentum flaps were used in all our cases. One case had perineal urethral mobilization to reach healthy urethral margins and tension-free vesicourethral anastomosis. Surgeries were uneventful, with no intraoperative complications reported. Median operative time, estimated blood loss, and length of hospital stay were 370 (291.3-453) minutes, 255 (175-262.5) mL, and 2.5 (2-3) days, respectively. Median Jackson-Pratt drains, Double-J stents and Foley catheter removal days were 6 (6-10), 38 (32-43), and 30 (27-41) days, respectively. No postoperative complications were reported. The median follow-up time was 16.25 (12-26) months, and no fistula recurrence was shown. ConclusionRobotic-assisted laparoscopic repair could represent an effective approach for the simultaneous repair of RVF with concomitant VUAS. More studies and management standardization are needed to assess the role of the robotic platform in the simultaneous repair of RVF with VUAS after radical prostatectomy.

Robotic Repair of Rectovesical Fistula: Combined Anterior and Posterior Approach with Omental Flap Interposition

Abstract Introduction and Objectives: Rectovesical fistulas are a rare but devastating complication of radical prostatectomy. Management can be challenging due to deep location in the pelvis and recent surgery. We present a case of a patient whose prostatectomy was complicated by unrecognized rectal injury and pelvic abscess. After diverting colostomy, he was referred for management of the resulting rectovesical fistula. The patient failed primary closure with a sliding rectal advancement flap. Methods: In this video, we demonstrate robotic repair of a rectovesical fistula. The fistula tract was first dissected posterior to the bladder. Due to the location of the fistula, a transvesical approach was also required to identify the distal end of the fistula. Once the fistula was completely separated from the bladder, it was primarily closed. An omental flap was then mobilized and secured over the fistula site. Results: The patient underwent successful repair using minimally invasive techniques, preventing th...

York‐Mason procedure for repair of recto‐urinary fistulae: a 40‐year experience

To review the use of the York-Mason transanal, transrectal procedure, used in properly selected patients over a 40-year period, for repairing recto-urinary fistulae. We retrospectively reviewed the medical records of all patients who underwent acquired recto-urethral or rectovesical fistula repair at our institution. A total of 51 patients have undergone York-Mason recto-urinary fistula repair at our institution during this time. Since our last report in 2003, we have performed this procedure an additional 27 times. We continue to have good results, with 25 of these patients having resolution of their fistulae after one procedure. Failures in the updated cohort were radiation-induced fistulae. We continue to find no evidence of faecal incontinence or stenosis after this procedure. Over a period of 40 years, the York-Mason posterior, transanal, transrectal correction of iatrogenic recto-urinary fistula has been highly successful, reliable and safe, when used for fistulae occurring after prostate surgery. Preliminary faecal diversion can often be avoided in selected patients.

Robotic Repair of Rectovesical Fistula Secondary to Open Radical Prostatectomy

Introduction: Rectovesical fistula (RVF) is a rare entity that can develop after trauma, radiation, congenital diseases, inflammatory bowel disease, and open radical prostatectomy. Herein we present our experience with robot-assisted fistula repair. Methods: Three patients were treated. The etiology of RVF developed was open radical prostatectomy in all patients. The robotic procedure was postoperative following failed open repair in two patients, and primary in the third. All patients had previously undergone fecal diversion. The operative steps were as follows: (1) cystoscopy, (2) RVF catheterization, (3) five-port transperitoneal laparoscopic mobilization of omental pedicle flap, (4) cystotomy extending toward the fistula tract, (5) robot docking, (6) dissection of the rectovesical plane, (7) interrupted rectal closure, (8) omental interposition, (9) bladder closure, (10) suprapubic tube placement, and (11) drain placement. Results: Mean operative time was 153 mins (range 120–180). No intraoperative or postoperative complications occurred. All patients remain free of fistula recurrence by cystographic studies with follow-up ranging from 2 weeks to 10 months. Bowel continuity has been restored in two patients and is planned in one. Conclusion: While we await longer follow-up and experience in larger series, robotic repair of RVF appears feasible and represents an attractive alternative to open or laparoscopic approaches. No competing financial interests exist. Runtime of video: 7 mins 55 secs

Laparoscopic Rectovesical Fistula Repair

Rectovesical fistula (RVF) is a rare complication of radical prostatectomy. A 62- year-old man with clinically localized prostate cancer underwent open radical prostatectomy that was complicated by rectal injury and subsequent RVF development. Conservative management failed, and the patient was referred for surgical correction. The operative steps consisted of (1) cystoscopy, (2) RVF catheterization, (3) ureteral catheterization, (4) five-port transperitoneal laparoscopic approach, (5) cystotomy, (6) opening of the fistulous tract, (7) dissection between the bladder and the rectum, (8) closure of the rectum, (9) interposition of omentum, (10) suprapubic cystostomy placement, (11) bladder closure, and (12) colostomy creation. The operative time was 240 minutes. The hospital stay was 3 days. The urethral catheter was kept indwelling for 4 days. At 8 weeks postoperatively, the suprapubic tube was removed and the colostomy reversed. At 1-month follow-up, the patient remains free of fistula recurrence. Laparoscopic rectovesical fistula repair is feasible and represents an attractive alternative to the standard approaches.

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.

Perinatal Findings in a Male Fetus with Congenital Megacystis and Anorectal Malformations

We report the perinatal findings in a male fetus with congenital megacystis and anorectal malformations. A 17-year-old primipara was referred to our department at 13 weeks of gestation for management of a 4.6 × 3.8 cm massive intra-abdominal fetal mass consistent with megacystis. The fetal thorax was severely compressed. We used a 22-gauge needle to perform intrauterine fetal vesicocentesis, removing 30 ml of fetal urine, decreasing the fetal bladder diameter/crown-rump length ratio from 65.7 to 17%. Cytogenetic analysis revealed a 46, XY karyotype. Intermittent bladder aspiration was performed weekly from 13 to 20 weeks of gestation and every 2–3 weeks from 21 to 35 weeks of gestation for the purpose of decompression. Mild dilation of both renal pelves was noted beginning at 20 weeks of gestation, however, neither progression of hydronephrosis nor development of oligohydramnios was noted. At 36 weeks of gestation, a live male neonate was delivered with a normal phallus, duodenal atresia, mild congenital heart defects, a distended bladder, bilateral hydronephrosis, megaureters, imperforate anus with rectovesical fistula, cryptorchidism and bilateral vesicoureteric reflux. The postnatal renal function was normal. He underwent serial operations including colostomy, anoplasty with repair of rectovesical fistula, duodeno-duodenostomy, bilateral re-implantation of ureters, orchiopexy and reduction cystoplasty. At 20 months of age, the child had normal renal function. The intravenous pyelogram showed normal functional kidneys, moderate megaureters and moderate megacystis. He underwent clean intermittent catheterization for residual urine. The recurrent urinary tract infections were under control.