York Mason Technique Research Articles

Modified York Mason Procedure for the Closure of a Complex Anterior Fistula in Ano

The York Mason procedure was initially described for the management of recto-urinary fistulae. Although this procedure may be difficult to perform, success rates and long-term outcomes are encouraging. Adopting this technique for the management of a complex non-recto-urinary fistula in ano may be reasonable. In this manuscript, the York Mason technique was modified to repair a complex type 4 anterior fistula in ano without involvement of the urinary system with good results.

Iatrogenic urethro-rectal fistula

Urethro-rectal fistula is a rare pathological entity, most often iatrogenic secondary to prostate surgery, or traumatic secondary to trauma of the pelvis. We report the observation of a 73-year-old patient who consults in urology for urinary discharge through the anus during urination. He is a type I diabetic patient under poorly monitored insulin, he was treated for repeated urethritis, operated 4 months ago for Fournier gangrene with the notion of traumatic urethral catheterization, he presented after the removal of the bladder catheter a dysuria with emission of urine from the anus during urination which motivated a consultation. On clinical examination, the scrotum is supple and well healed after flattening the necrotic areas; absence of cutaneous fistulous pathways; in the digital rectal examination, a small induration is found at 6 cm from the anal margin class II according to the Rivera classification, with a firm prostate of 55 g. Retrograde urethrocystography (A, B, C, D) showed the presence of a urethro-rectal fistula with the presence of multiple moniliform narrowing of the anterior urethra in favor of chronic urethritis with muscular bladder and post-voiding residue. Trans-sphincter posterior surgical procedure according to the York-Mason technique has been proposed to treat this patient.

Mid term functional results following surgical treatment of recto-urinary fistulas postprostate cancer treatment

To evaluate the mid term functional results of patients treated for RUF and to determine an optimal treatment strategy to improve their quality of life. Recto-urinary Fistula (RUF) is a rare complication following prostate cancer treatment, and can have a major impact on patients' quality of life. There is a lack of consensus concerning the best approach and different techniques have been proposed: endoscopic, transrectal, perineal and transperitoneal (open, laparoscopic or robotic). We retrospectively reviewed the charts of patients who underwent RUF repair from January 2001 to December 2010 at our Institute. 16 patients who developed RUF following prostate cancer treatment were included in the study. The fistula had to be confirmed both clinically and by imaging. All patients had follow up consultation every 3 month for the first year and then annually. They were asked to fill questionnaires evaluating functional outcomes. The International Continence Society (ICS) score was used to assess the postoperative urinary continence. Fecal continence was evaluated with the Wexner score and sexual function was assessed with the International Index for erectile function (IIEF-5) score. Eighty-seven percent patients (14/16) in our series developed RUF as a consequence of prostate cancer surgery and 13% (2/16) postbrachytherapy (BT). All patients initially had a diversion colostomy and a supra pubic catheter. 69% (11/16) underwent primary YM repair and 73% (8/11) were successful. 2/3 primary failures were successfully retreated with graciloplasty. Primary gracilis flap interposition (GFI), on 3 non-irradiated patients were successful (100%). Primary GFI postbrachytherapy, no patient had recover urinary and digestive continuity. In total primary GIF was successful in 60% (3/5). Over all long term, success rate with a urinary and digestive continuity and without recurrence of the fistula was 81% (13/16). Mid term functional results were evaluated at mean follow up of 40 months (14-92). 13% (2/16) achieved complete urinary continence, 48% (7/16) required single pad, 25% (4/16) developed major incontinence, 7% (1/16) required urinary diversion and 13% (2/16) developed complete urethral closure post BT requiring permanent suprapubic catheterization. Colostomy was reversed in 93% (15/16) cases. 75% (12/16) achieved complete faecal continence, minor incontinence (wexner score 3-4) was seen in 13% (2/16) and major incontinence (wexner score 14) in 7% (1/16) and 7% (1/16) required a long term colostomy. 19% (3/16) developed colostomy related complications. Only 13% (2/16) achieved adequate erections with the use of intra cavernosal prostaglandin injections. RUF following prostate cancer treatment is a serious complication with severe repercussion on patients' quality of life. Surgical repair with the York Mason technique or Gracilis Flap interposition is associated with good success rates. If available pediculed gracilis muscle should be used as it offers better success rates. 3.

Modified York Mason technique for repair of iatrogenic rectourinary fistula: 20 years of experience

Modified York Mason technique for repair of iatrogenic rectourinary fistula: 20 years of experience

Modified York Mason technique for repair of iatrogenic recto-urinary fistula: 20years of the Montsouris experience.

Iatrogenic recto-urinary fistulas are a disastrous complication of therapeutic interventions on the prostate. Many surgical approaches have been described to repair recto-urinary fistulas and no consensus has been reached regarding the better approach. The objective of this study is to present the results of our updated 20-year experience in the surgical management of recto-urinary fistula using a modified York Mason procedure. We proceed to a retrospective single-institution review of surgically treated patients for iatrogenic recto-urinary fistulas between 1998 and 2017 by the modified York Mason technique. Descriptive analysis of our population was performed. Continuous and categorical variables were compared using Mann-Whitney and Fischer tests, respectively. All tests were two-sided with a significance level set at p value <0.05. We included 30 consecutive patients treated for iatrogenic recto-urinary fistula. The median follow-up was 76months (2-195). The median size of the fistula was 5mm (2-20). Successful healing of the recto-urinary fistula was observed in 80, 97, and 100% of patients after 1, 2, or 3 York Mason procedure. During the study period, no one single case of acquired urinary incontinence or durable fecal incontinence has been observed. Our modified York Mason technique is a reliable and effective procedure with a 100% success rate for the repair of small iatrogenic recto-urinary fistulas in non-irradiated patients. It has a very low morbidity rate, and no case of postoperative urine or fecal incontinence has been observed.

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.

Traitement des fistules uréthro-rectales par voie trans-anorectale de York Mason : technique et résultats

To report our experience for the management of urethro-rectal fistula by the York Mason technique. We retrospectively analyzed the data of patients treated surgically for FUR by the technique of York Mason, between 2000 and 2012. Seventeen patients were included in the study. All patients had a bowel diversion before surgery. We observed four recurrences of FUR (23.5%). Recurrences occurred in a radiation field for two patients and in a oncologic recurrence for 1 patient. The fourth recurrence was treated by a second procedure of York Mason successfully. In our study, the York Mason technique was safe and reproducible for the treatment of FUR. The main factor of failure was a history of pelvic radiotherapy.

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.

York Mason Procedure to Repair Iatrogenic Rectourinary Fistula: Our Experience

Rectourinary fistula (RUF) is an uncommon but devastating condition in men. It usually occurs as a complication of prostatic cancer treatment, whether this is by radiation therapy or surgery. It can also occur in patients with benign pathology of the prostate, inflammatory bowel disease, or Fournier's gangrene, and following pelvic trauma. RUF represents a challenge for the surgeon because spontaneous closure is a rare event. Several techniques have been described for surgical repair of fistula. The goal of the present study was to demonstrate that the York Mason posterior, transrectal correction of an iatrogenic RUF is a reliable approach that offers good postoperative outcomes. We retrospectively reviewed the medical records of 39 patients who underwent York Mason repair from 1998 to 2012 at the University of Southern California (USC) and Campus Bio-Medico University of Rome (UCBM). The most frequent common causes of RUF were itemized, and statistical analysis was performed to determine correlations between the fistula's etiology and surgical outcome. Patients were then divided into two different cohorts: those who had undergone only one previous procedure (group 1) and those who had undergone two or more surgeries (group 2). We performed a statistical analysis between the two groups and calculated the percentage of fistula repair by means of the posterior trans-sphincteric approach with the York Mason technique in each groups We evaluated the presence of comorbidities (diabetes and infection) and their influence on the surgical outcome. Finally, we reported patient outcomes during follow-up. In the present series, the RUF was iatrogenic in every case. The onset of the fistula followed prostate cancer treatment, most commonly after laparoscopic procedures. The success rate of fistula repair was found to be independent of the fistula's etiology. Diabetes and infections did not influence the surgical outcome. Overall, more than 50 % of patients treated with the York Mason posterior, transanal, transrectal approach remained free of fistula during follow-up. Almost 90 % of those who were previously operated only once remained free of fistula. The posterior trans-sphincteric approach of the York Mason technique is effective in treating RUF.

Outcome of a Modified York Mason Technique in Men With Iatrogenic Urethrorectal Fistula After Radical Prostatectomy

Urethrorectal fistula formation is a rare but devastating complication after radical prostatectomy. Reconstructive surgery is usually required, and one surgical option is the York Mason procedure. We present our experience with a modified York Mason technique for the surgical management of urethrorectal fistula. Retrospective review of medical records. Tertiary care university medical center. Consecutive male patients with urethrorectal fistula due to radical prostatectomy who underwent York Mason repair between 1998 and 2009. All patients initially received both a urinary and a bowel diversion as the first step of the treatment. The second step consisted of a modification of the York Mason technique in which the approach began with a parasacrococcygeal incision extending from the coccyx to the anal verge. All patients were seen 3, 6, and 12 months after surgery and yearly thereafter to assess the resolution of clinical functional disorders and the Wexner fecal incontinence score. The study included 10 men with a mean age of 63.7 (range, 50-80) years who had urethrorectal fistula after open retropubic prostatectomy (n = 6) or after laparoscopic prostatectomy (n = 4). Confined prostate cancer (pT2) was found in 7 patients and extracapsular extension of the tumor (pT3) in 3 patients. Urethrorectal fistula was discovered because of fecaluria in 6 patients and pneumaturia in 6. The mean time from surgery to York Mason repair was 15 (range, 4-42) months. Five patients had each previously undergone 1 unsuccessful repair procedure. The mean operative time was 81 (range, 60-130) minutes and the mean hospital stay was 6 days. No fecal incontinence or anal stenosis developed after York Mason repair. No recurrence of urethrorectal fistula occurred during a mean follow-up of 24 (range, 18-38) months. Lack of objective fecal continence data. : York Mason repair appears to be a safe and effective approach for management of urethrorectal fistula. The rates of fistula closure and symptom resolution are encouraging, and patients show rapid postoperative recovery with minimal morbidity. Thus, York Mason repair should always be considered for treatment of urethrorectal fistula after radical prostatectomy.

Surgical Treatment of Iatrogenic Rectourinary Fistula—York-Mason Technique—a Case Report

Introduction. Recto-urinary fistulas resulting from trauma or surgery are a serious and debilitating complication. They represent a challenge not only because of the difficulty on choosing the best technique to solve them but also because of the risk of recurrence. Spontaneous cure is rare. Materials and Methods. We describe the case of a 61-years-old man that on the 9th postoperative day of a laparoscopic radical prostatectomy (LRP) started with fecaluria and liquid faeces. Recto-urinary fistula was confirmed at the 10th postoperative day by CT scan and contrast enema. Discussion. We chose the York-Mason technique, because it is simple to perform, effective and has minimal morbidity. This is a posterior, transrectal, and transsphincteric approach, carried out on healthy tissues without previous scarring phenomena. Results. The postoperative period progressed without complications, and the patient discharged on the 4th day. The closure of the fistula was confirmed radiologically by retrograde cystography after 4 weeks allowing the removal of drainage catheter. The reconstruction of intestinal transit was carried out 2 months later. Conclusion. The York-Mason technique, a transrectal and transsphincteric approach with minimal morbidity, proved to be effective on the resolution of the recto-urinary fistula, a rare complication of the radical prostatectomy.

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 ...

Rectourinary Fistula after Radical Prostatectomy: Review of the Literature for Incidence, Etiology, and Management

Although rectourinary fistula (RUF) after radical prostatectomy (RP) is rare, it is an important issue impairing the quality of life of patients. If the RUF does not spontaneously close after colostomy, surgical closure should be considered. However, there is no standard approach and no consensus in the literature. A National Center for Biotechnology Information (NVBI) PubMed search for relevant articles published between 1995 and December 2010 was performed using the medical subject headings “radical prostatectomy” and “fistula.” Articles relevant to the treatment of RUF were retained. RUF developed in 0.6% to 9% of patients after RP. Most cases required colostomy, but more than 50% of them needed surgical fistula closure thereafter. The York-Mason technique is the most common approach, and closure using a broad-based flap of rectal mucosa is recommended after excision of the RUF. New techniques using a sealant or glue are developing, but further successful reports are needed.

Incidence, Clinical Symptoms and Management of Rectourethral Fistulas After Radical Prostatectomy

Rectourethral fistula is a rare but severe complication after radical prostatectomy and there is no standardized treatment. We retrospectively evaluated the incidence, symptoms and management of rectourethral fistulas based on our experience. From 1999 to 2008 we performed 2,447 radical prostatectomies. Patients in whom postoperative rectourethral fistulas developed were identified. Based on the therapeutic approach patients were categorized into group 1-conservative treatment, group 2-colostomy with or without surgical closure and group 3-immediate surgical closure without colostomy. Rectourethral fistulas developed in 13 of 2,447 patients (0.53%) after radical prostatectomy. The risk of rectourethral fistulas was 3.06-fold higher (p = 0.074) for perineal (7 of 675, 1.04%) than for retropubic prostatectomy (6 of 1,772, 0.34%). In 7 of 13 patients (54%) a rectal lesion was primarily closed at radical prostatectomy. Median followup was 59 months. In all patients in group 1 (3) the fistula closed spontaneously with conservative treatment. None of these patients had fecaluria. In group 2 of the 9 patients 3 (33%) experienced spontaneous fistula closure after temporary colostomy and transurethral catheterization. In this group 6 patients (67%) required additional surgical fistula closure, which was successful in all. Surgical fistula closure (1) without colostomy in presence of fecaluria failed (group 3). The therapeutic concept for rectourethral fistulas should be guided by clinical symptoms. Rectal injury during radical prostatectomy is a major risk factor. In cases with fecaluria colostomy is required for control of infection and may allow spontaneous fistula closure in approximately a third of cases. In the remainder of cases surgical fistula closure was successful in all after protective colostomy.

Modified York-Mason Technique for Repair of Iatrogenic Rectourinary Fistula: The Montsouris Experience

Rectourinary fistula is a devastating complication of rectal and genitourinary surgery. Spontaneous closure is rarely successful and failure in conservative management calls for surgical intervention. We present our experience with rectourinary fistula repair using a modified York-Mason technique. We retrospectively reviewed the medical records of all 12 patients who underwent modified York-Mason repair at our institution between 1998 and 2008. Rectourinary fistula developed in 10 patients after radical prostatectomy and in 2 following high intensity focused ultrasound. Six patients were initially treated with fecal diversion. Our approach begins with a transanal incision at the 2 o'clock position representing a modification of the classically described midline incision extending from the coccyx to the anal verge. Key aspects of the York-Mason procedure are maintained. However, we do not close the urethra after fistula excision, and instead perform a multilayer, nonoverlapping closure of the anterior rectal wall only. With a median followup of 22 months we observed the complete resolution of rectourinary fistula in all 12 patients. Three patients required multiple York-Mason procedures to achieve resolution of symptoms. All patients reported intact fecal continence. Median operative time and estimated blood loss were 63 minutes and 100 ml, respectively. Median hospital stay was 4 days. Our modified York-Mason technique is safe and effective for the repair of small, iatrogenic rectourinary fistula. We report 75%, 92% and 100% rectourinary fistula resolution after 1, 2 and 3 York-Mason procedures, respectively, with 100% fecal continence. This technique can be performed multiple times without a significant increase in operative time, estimated blood loss or fecal incontinence.

Management of Severe Urethral Complications of Prostate Cancer Therapy

We present our management of urethral stenosis and rectourinary fistula resulting from prostate cancer therapy. We concentrated on cases refractory to minimally invasive treatment, such as dilation, urethrotomy, and urinary and/or fecal diversion. In our prospectively collected urethral reconstruction database we identified patients who underwent reconstruction of urethral stenosis or rectourinary fistula who also received prior treatment for prostate cancer. We documented demographics, prostate cancer pretreatment characteristics, prostate cancer therapy type, urethral reconstruction type and success. A total of 48 patients met the inclusion criteria, including 16 with rectourinary fistula and 32 with urethral stenosis. Urethral complications followed prior radical prostatectomy, brachytherapy, external beam radiotherapy, cryotherapy, thermal ablation and any combination of these procedures. Stenosis repair was successful in 23 of 32 cases (73%) and it differed little between anterior and posterior urethral stenosis. Repair was accomplished by anastomotic urethroplasty in 19 cases, flap urethroplasty in 2, perineal urethrostomy in 2 and a urethral stent in 9. Prior external beam radiotherapy was a risk factor for urethral reconstruction failure. Fistula repair was successful in 14 of 15 patients (93%), excluding 1 who died postoperatively. The complexity of fistula management was dictated by fistula size and the presence or absence of coincident urethral stenosis. Urethral stenosis or rectourethral fistula following prostate cancer therapy can be managed by urethral reconstruction, such that normal voiding via the urethra is maintained, rather than abandoning the urethral outlet and performing heterotopic diversion. This can be accomplished with an acceptable rate of failure, given the complexity of the cases.

Successful Repair of Iatrogenic Rectourinary Fistulas Using the Posterior Sagittal Transrectal Approach (York‐Mason): 15‐Year Experience

Rectourinary fistulas (RUFs) represent a challenging clinical problem. Most RUFs are secondary to lower urinary or intestinal tract surgery. Several surgical approaches have been proposed. The aim of this study was to review a 15-year experience using the York-Mason posterior sagittal transrectal approach to iatrogenic RUFs. Seven patients with RUFs secondary to urologic surgery were operated on with the York-Mason technique at the Department of Urology, University of Padova, Italy between 1988 and 2003. The patients' data have been collected and analyzed retrospectively. All the patients were treated successfully (100%). In one patient with Crohn's disease the fistula recurred 11 years after the first surgery. One patient died for metastasis of prostate cancer 1 year after surgical repair of the RUF. A temporary colostomy was performed in five patients; the colostomies were subsequently closed, and the patients regained complete fecal continence with no postoperative anal strictures. The colostomy remained in place in one patient with Crohn's disease and in another with ulcerative rectocolitis. The posterior sagittal transrectal approach provided easy access and identification of RUFs and good surgical exposure, with no subsequent strictures or fecal incontinence. Our data show that the York-Mason technique alone is a highly effective option for treating an iatrogenic postoperative RUF.

Relapsing Recto Vescical Fistula Treated According to the York Mason Technique

Recto-urinary fistulas are a rare event and their therapeutic management can be different. We present the case of a relapsing recto-vesical fistula, non-responsive to multiple therapeutic approaches, which was finally treated according to the York Mason technique to have immediate access to the fistula.