York-Mason Approach Research Articles

Transsphincteric Repair of Rectourethral Fistulas in Combination With Dartos Muscle Flap Interposition Following Radical Prostatectomy

OBJECTIVETo present our experience with a novel technique that combines the York–Mason transsphincteric approach with dartos muscle flap interposition to treat rectourethral fistulas. METHODSWe extracted records from our prospectively kept database of 35 procedures conducted for treating rectourethral fistulas during 2002–2023; the York–Mason approach was combined with dartos muscle flap interposition in five cases, performed for treating rectourethral fistulas due to radical prostatectomy, all of which were referral cases. RESULTSAll five patients were successfully treated and followed up for a median of 70.0 months without recurrence. Before the fistula repair, all had a diverting stoma. In all cases, the first voiding cystourethrogram revealed a healed fistula. The posterior and the scrotal incisions healed uneventfully. All patients reported normal voiding and no urinary incontinence. To date, the stoma has closed in three patients, all of whom had intact fecal continence and no postoperative anal stenosis. CONCLUSIONThe transsphincteric modified York–Mason approach combined with dartos muscle flap interposition resulted in complete healing of rectourethral fistulas.

Transsphincteric repair of rectourethral fistulas: 15 years of experience with the York Mason approach.

To evaluate the surgical and functional outcomes of our single institution's 15-year experience with surgically treated rectourethral fistulas using a modification of the York Mason technique. Prospectively recorded data between 2002 and 2016 of all patients who underwent transsphincteric repair of rectourethral fistula using a modified York Mason technique at Eskilstuna County Hospital, Eskilstuna, Sweden, were assessed. A total of 20 consecutive patients, including 17 referrals (85%) and three patients (15%) from our hospital have undergone the modified York Mason procedure. The surgical and functional outcomes were evaluated. Of the 20 patients, 18 were repaired successfully (90%), and one was combined with a dartos muscle interposition flap. No fistula recurrence occurred in the 18 successful repairs during the median follow-up time of 84.7 months. Before fistula repair, 12 patients (60%) underwent a diverting stoma. The remaining eight patients (40%) underwent repair and synchronous diverting stoma. We did not find any significant differences between patients in which the repair was successful compared with patients with failed repair, but diabetes, smoking and preoperative irradiation were much more frequent in the failed group. Of the 18 patients who had a successful repair, 17 patients experienced normal voiding and no urinary incontinence. One patient was suffering from postprostatectomy incontinence before rectourethral fistula repair, and was successfully treated with Scott prosthesis. All the 13 patients in whom the stoma had been closed reported intact fecal continence and no anal stenosis postoperatively. The transsphincteric modified York Mason approach offers excellent exposure and a high fistula closure rate without fecal and urinary incontinence.

AB061. Trickier and tips for surgical treatment of complex male urethral fistula

The male urethral fistula is the common and difficult complication of the surgical treatments of urethral stricture, hypospadias and prostate disease. Surgical reconstruction remains the mainstay in the management. Sometime the surgical therapy of the male urethral fistula is still a challenge. The key point of the treatment of anterior urethral fistula is using Dartos Fascia flap to overlapping it in one-two layer fashion. For posterior urethra, rectourethral fistula is great challenge. But unfortunately, the rectourethral fistula is becoming increasingly common with earlier diagnosis of prostate cancer, which is amenable to treatment with radical prostatectomy. Surgical approaches for definitive repair include the perineal, transanal, and combined abdominoperineal approaches. Perineal approach is good for rectourethral fistula with posterior urethral stricture. Transanal approach, the York-Mason approach, is good choice for small rectourethral fistula without posterior urethral stricture. We also use a new approach with combine perineal approach with transanal approach for some big rectourethral fistula without posterior urethral stricture. Among the numerous methods for closure of rectourinary fistulae, no single procedure has been proved most efficacious. However, it has become clear that a more aggressive surgical approach is necessary when local tissue integrity is dubious.

York Mason Procedure to Repair Iatrogenic Rectourinary Fistula

A rectourethral fistula is a devastating complication of prostatectomy that is difficult to treat and may have significant implications for the patient with respect to quality of life after repair. Falavolti and colleagues have reviewed and published their results in employing the York Mason approach to repair of these fistulas [1]. As they so aptly describe, the surgical approach to rectourethral fistula varies and is often related to the etiology of the fistula. Fistulas that are the result of an iatrogenic injury at the time of prostatectomy are small and more easily managed than those caused by severe prostate and rectal necrosis secondary to radiation therapy for prostate cancer. Therefore the method of surgical repair varies. Hechenbleikner et al. [2] in a recent literature review on rectourethral fistula repair, identified four primary approaches to repairing these defects: transanal, transabdominal, trans-sphincteric, and transperineal. Now, we can clearly add the York Mason approach to that list. However, the overall results from the York Mason approach described are not as promising as those seen with more traditional repairs. The authors report only a 50 % success rate, which compares to a 90 % closure rate when using a transperineal approach [2]. The transperineal approach uses an interposition graft of either muscle, usually the gracilis muscle from the leg, or a buchal mucosal flap, which is not described with the York Mason technique. The transperineal or transanal approach also has the added benefit of not dividing the anal sphincter muscles, which may alter longterm fecal continence in patients. The authors of the present study have a large percentage of patients who have undergone more that two repairs before seeking their services, and this must be taken into account when reviewing the data they report with the York Mason approach. This York Mason technique may provide a clean nonviolated approach to the fistulous tissue after prior repairs have been attempted, and therefore perhaps this technique should be reserved for patients who have failed transanal or transperineal repairs. The addition of a flap such as the buchal mucosal flap to the York Mason approach may add further benefit and result in higher success rates. The factors that determine whether a patient with a rectourethral fistula will undergo a definitive local repair or an excision with either permanent fecal or urinary diversion include the degree of tissue destruction, the etiology of the fistula, and the continence of both systems. Small defects in patients who have maintained urinary control are still best served by the transperineal approach with gracilis or other muscle interposition. Those with significant tissue destruction and loss of continence may be best served with permanent urinary diversion and either fecal diversion, if they have poor sphincter function, or repair of the rectal defect. Those with severe radiation proctitis as a cause of fistula may require a proctectomy, but they may also be candidates for coloanal anastomosis. For those that have had failed traditional repairs and recurrence, and who wish to maintain urinary function, the York Mason approach may be the best bet for obtaining successful closure.

URORECTAL FISTULAE FOLLOWING THE TREATMENT OF PROSTATE CANCER

Sir, Surgical management of urorectal fistulae (URF) remains a reconstructive challenge to most practicing urological surgeons. Several techniques have been described to repair URF, despite the fact that a ‘gold standard’ technique for management of URF does not exist. The paper by Mundy et al. [1] provides an excellent revision of the literature about URF and their experience in URF surgical management, but suggested that ‘The York Mason procedure is now obsolete’ based on the two standard colo-rectal surgery textbooks [2,3], ‘at least in part because of the high incidence of fecal incontinence [2,3] and fistulation’[4,5]. The four references cited by Mundy et al. [1] are 10 years old or more and no mention is made of recent publications by centres with successful experience with the York Mason approach [6–12] (Table 1). After reading the Mundy et al. [1] paper meticulously, I would like to state my point of view. The York Mason parasacrococcygeal transsphinteric approach remains one of the most suitable techniques for the treatment of URF, as it provides a maximum chance of success with limited morbidity and preservation of anal continence [6]. This approach was first reported in 1969 [13] and has recently aroused renewed interest [6,14] We agree with some of the conclusions of Mundy et al. [1] that URF surgery has changed in the last 25 years because the aetiology has changed. Nowadays, it usually follows treatment for prostate cancer and is more common because radical prostatectomy is much more common, the increased use of a minimally invasive approach, multimodality treatment; and because of the increased use of salvage treatment in selected cases. Radiotherapy induced URF are usually complex because they have to be approached differently and usually repaired with interposition flap to support the graft and separate the rectal suture line. However, URF after radical prostatectomy may be successfully treated with different techniques. The type of repair must be based on surgeon experience using the most successful technique with lest morbidity. We still think that the York Mason approach represent a good option for the treatment of URF.

Twenty-year experience with surgical management of recto-urinary fistulas by posterior sagittal transrectal approach (York-Mason)

We describe our 20-year experience with a posterior transrectal approach (York-Mason procedure) to treat recto-urinary fistula (RUF). Most RUFs are secondary to lower urinary or intestinal tract surgery. Spontaneous closure is infrequent, and operative treatment is often mandatory. Several surgical approaches have been proposed. We reviewed retrospectively the medical records of 14 patients presenting with RUF in our Department between 1988 and 2010. In 10 patients, RUFs developed after radical retropubic prostatectomy (RRP); in the other 4 patients, RUFs resulted after other surgical interventions. All patients were treated with the York-Mason approach. A temporary colostomy and suprapubic cystostomy were performed in all patients except one. All patients were treated successfully. After fistulectomy, colostomies were closed after 4 mo, and patients reported fecal continence and no postoperative anal strictures. The colostomy was left in place permanently in 1 patient due to the simultaneous presence of Crohn's disease, in another with ulcerative rectocolitis, and in a third scheduled for adjuvant radiotherapy for relapse after RRP. In 1 patient, daily medications were essential because of wound infection. In the patient with Crohn's disease, the fistula recurred 11 years after first repair. Two patients died of metastatic prostate cancer 1 year after repair of the RUF. The posterior sagittal transrectal approach allows easy access and good surgical exposure, facilitating identification of the fistulous tract. In our opinion, the York-Mason approach guarantees the greatest success rate with the least morbidity.

V1877 MANAGEMENT OF RECTOURINARY FISTULA: THE YORK MASON APPROACH

You have accessJournal of UrologyBladder Oncology & Reconstruction1 Apr 2011V1877 MANAGEMENT OF RECTOURINARY FISTULA: THE YORK MASON APPROACH Vincent Flamand, Rafael Sanchez-Salas, François Rozet, Eric Barret, Xavier Cathelineau, Marc Galiano, and Guy Vallancien Vincent FlamandVincent Flamand Lille, France More articles by this author , Rafael Sanchez-SalasRafael Sanchez-Salas Paris, France More articles by this author , François RozetFrançois Rozet Paris, France More articles by this author , Eric BarretEric Barret Paris, France More articles by this author , Xavier CathelineauXavier Cathelineau Paris, France More articles by this author , Marc GalianoMarc Galiano Paris, France More articles by this author , and Guy VallancienGuy Vallancien Paris, France More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1980AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The York Mason parasacrococcygeal transsphinteric approach remains one of the most suitable techniques for the treatment of rectourinary fistulas. as it provides a maximum rate of success with limited morbidity. To report current experience with the York Mason approach. METHODS 19 patients with rectourinary fistulas after radical prostatectomy (n=17) or HIFU (n=2) were treated with the York Mason operation from 1998 to 2010. All patients had a complete division of the anal sphincters and accurate suture of the divided muscle, achieving adequate restoration of the anatomical layers. The technique implied a resection of the fistula with minutely precise closure of the intestinal tract and urinary catheterization. Technique: Patient's placed in a jack-knife fashion. A paracoccigeal incision is performed and matched paired sutures placed in anal sphincter before its incision. Fistula dissection and excision is performed, then anterior rectal wall closure is closed. Finally knotting of sphincter paired sutures is done and the skin is sutured. RESULTS 19 patients have been treated with 20 months follow period and 80%, 95% and 100% rectourinary fistula resolution after 1 (n=16) , 2 (n=2) and 3 (n=1) York-Mason procedures, respectively, with 100% fecal continence. Median operative time was 70 minutes [56–150] and median blood loss 110 ml [5–600]. CONCLUSIONS Parasacrococcygeal transsphinteric approach features a high rate of resolution for rectourinary fistulas surgical treatment. The York Mason operation holds a high rate of continence with low morbidity. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e752-e753 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vincent Flamand Lille, France More articles by this author Rafael Sanchez-Salas Paris, France More articles by this author François Rozet Paris, France More articles by this author Eric Barret Paris, France More articles by this author Xavier Cathelineau Paris, France More articles by this author Marc Galiano Paris, France More articles by this author Guy Vallancien Paris, France More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

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

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 ...

UP-2.69: York Mason approach: a good technique for the management of urethrorectal fistulas

UP-2.69: York Mason approach: a good technique for the management of urethrorectal fistulas

VID-1.06: Management of rectourinary fistula: the York Mason approach

The York Mason parasacrococcygeal transsphinteric approach remains one of the most suitable techniques for the treatment of rectourinary fistulas as it provides a maximum rate of success with limited morbidity. The objective is to report current experience with the York Mason approach.

Acquired recto-urethral fistula in children: Long-term follow-up

Acquired recto-urethral fistula is an uncommon entity in children and occurs as a consequence of pelvic disorder, including trauma, iatrogenic injury, inflammatory bowel disease, pelvic neoplasm and infection. We have reviewed our experience with treatment of recto-urethral fistula and focussed on the outcome of the repair. Data collected included demographics, cause, procedure type, presentation, operative details and morbidity. Telephonic and personal contact were made to evaluate functional outcome and quality of life. Between 1991 and 2008, 17 children with a mean age of 7 years were treated for recto-urethral fistula. Fifteen cases were of iatrogenic origin and two were following road traffic accident. Six underwent repair through the York-Mason approach; the remaining 11 were treated via the transperineal approach with interposition of vascularised tunica vaginalis flap. Operating time, success rate and overall satisfaction score were similar for the two groups. Both approaches used were effective to treat recto-urethral fistula. Successful repair can be achieved with minimal morbidity, short hospital stay, and good postoperative outcome and quality of life.

Devastating complications after brachytherapy in the treatment of prostate adenocarcinoma.

To report a retrospective chart review of patients who developed recto-urethral fistula (RUF) or several bladder neck contracture (BNC) recurrences after brachytherapy for treating localized prostate cancer. In the past 3 years 18 patients with devastating complications after prostate brachytherapy were referred to our centre (RUF in 11, BNC in seven; mean age 63 years, range 60-81). All patients with RUF initially underwent diverting colostomy (six cystoprostatectomy with closure of the fistula, omental interposition and urinary diversion; one prostatectomy, bladder neck closure, fistula closure with omentum flap and continent vesicostomy). Three patients had the fistula closed with gracilis muscle flap using the York-Mason approach (one had a bladder neck closure and suprapubic tube; one elected to have no treatment). All patients with BNC had received three or more procedures to resect or incise their contracture. Four had diversion with a catheterizable segment, two used an indwelling Foley catheter and one uses intermittent catheterization. All six patients who had cystoprostatectomy with urinary diversion have had no recurrence of their RUF. All three treated with the York-Mason procedure healed well. One developed recurrent prostate adenocarcinoma and two a secondary neoplasia in the prostate or rectum (leiomyosarcoma and neuroendocrine, respectively). The enterocystoplasty patient developed sepsis after colostomy reversal and subsequently died. In those patients with BNC, the four who underwent urinary diversion fared well; two tolerate the indwelling catheter poorly, and the seventh uses intermittent catheterization with occasional difficulty. Brachytherapy with or without external irradiation can be associated with severe complications. RUF managed with aggressive anterior pelvic exenteration and urinary diversion can be associated with excellent results. The York-Mason procedure in patients with an adequate urinary continence mechanism and bladder dynamics may provide good functional results. The presence of a secondary malignancy in patients deserves further investigation. Many recurrences of a BNC tend be refractory to transurethral resection/incision; indwelling catheters are then poorly tolerated and patients may require a major reconstructive procedure.

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.

The York Mason Approach to Repair of Iatrogenic Rectourinary Fistulae

The York Mason Approach to Repair of Iatrogenic Rectourinary Fistulae

The York Mason Approach to Repair of Iatrogenic Rectourinary Fistulae

Background We report our experience of 8 patients who underwent repair of iatrogenic rectourinary fistulae via the transsphincteric (York Mason) approach. Patients and Methods Eight patients developed rectourinary fistulae in the course of treatment of prostate cancer. Three fistulae developed after radiation therapy alone, three after prostatectomy, and two after both surgery and radiation therapy. Five patients underwent fecal diversion in conjunction with repair. Results All fistulae remained closed after repair. All patients were continent of stool after primary surgery or after colostomy closure if they had been diverted. Two patients had complications associated with urethral catheters that resolved with changing the catheters. Conclusion The transsphincteric (York Mason) approach in the repair of rectourinary fistulae results in successful closure of the fistulae without impairment of continence to stool. This procedure is much simpler than complicated transabdominal or transperineal approaches to these fistulae.

The York Mason approach to repair of iatrogenic rectourinary fistulae

We report our experience of 8 patients who underwent repair of iatrogenic rectourinary fistulae via the transsphincteric (York Mason) approach. Eight patients developed rectourinary fistulae in the course of treatment of prostate cancer. Three fistulae developed after radiation therapy alone, three after prostatectomy, and two after both surgery and radiation therapy. Five patients underwent fecal diversion in conjunction with repair. All fistulae remained closed after repair. All patients were continent of stool after primary surgery or after colostomy closure if they had been diverted. Two patients had complications associated with urethral catheters that resolved with changing the catheters. The transsphincteric (York Mason) approach in the repair of rectourinary fistulae results in successful closure of the fistulae without impairment of continence to stool. This procedure is much simpler than complicated transabdominal or transperineal approaches to these fistulae.

Acquired Rectourethral Fistula: Methods of Repair

Rectourethral fistulas are a rare but devastating complication of urinary or rectal surgery, trauma or inflammation. Historically repair has posed a challenge because of technical difficulties and the high incidence of recurrent fistulas. We report 7 cases of acquired rectourethral fistulas of varying etiology (3 after prostatectomy, 3 after trauma and 1 after recurrent perineal abscess), which were managed by various means. Our data and those in the literature suggest that the first attempt at repair is the best and subsequent repairs become increasingly difficult; the York Mason approach allows easy accessibility with minimal risk of complications and the best chance for a functionally successful outcome when a vascularized flap is not required, and some cases may have such a low probability of successful resolution of the fistula as well as maintenance of urinary continence that cystectomy and supravesical diversion are appropriate considerations.

A Parasacral Approach to Rectal Prolapse

A posterior parasacral approach is introduced for management of third-degree rectal prolapse. Anterior approximation of the levator musculature and posterior fixation of the rectum are accomplished readily through the York Mason approach.