Surgical Treatment of Rectourethral Fistulae

Trippitelli, A; Barbagli, Guido; Lenzi, R.; Fiorelli, C.; Gc, Masini

doi:10.1159/000472547

Cited by 31 publications

(10 citation statements)

References 11 publications

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“…5,6 As with any rare or complicated surgical problem, many types of repairs have been described, including transperineal, transsphincteric, and transanal flap repairs; gracilis muscle interposition; transabdominal repair; and transanal endoscopic repair. [7][8][9][10][11][12] These repairs are supported by data from many studies. [13][14][15][16][17][18] Other studies report modified repairs including a combination of the transsphincteric approach with advancement flap closure, combination rectal advancement flap and gracilis muscle interposition, transsphincteric approach without diversion, and perineal approach with gracilis muscle interposition.…”

supporting

confidence: 57%

“…11,34 This repair is limited by exposure of the relevant anatomy from the abdominopelvic side and can be associated with impotence and urethral stricture. 11 The transsphincteric approach (York-Mason) provides excellent exposure and has a nearly 100 percent success rate in most studies. Complication rates are low, and initial reports of fecal incontinence have not been substantiated.…”

mentioning

confidence: 99%

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Rectal Advancement Flap Repair of Rectourethral Fistula

Garofalo

Delaney

Jones

et al. 2003

Diseases of the Colon &Amp; Rectum

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supporting

confidence: 57%

mentioning

confidence: 99%

Rectal Advancement Flap Repair of Rectourethral Fistula

Garofalo

Delaney

Jones

et al. 2003

Diseases of the Colon &Amp; Rectum

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“…A case report by Miller W. showed that the greater omentum is another tissue that can be used as means of repair because of its location and rich vascular supply [27]. The main problem with using an omental flap is obtaining it via an invasive laparotomy [28], which may not be a practical approach if the patients undergoing the surgery has had prior abdominal surgeries. Together, the natural thickness of the muscle, which offers a physical structure able to separate the URF, and its optimal and easily accessible anatomical position, make the gracilis an ideal muscle to transpose in order to inhibit the recurrence of URF [26].…”

Section: Discussionmentioning

confidence: 99%

Treatment of urethrorectal fistulas caused by radical prostatectomy – two surgical techniques

Połom

Krajka

Fudalewski

et al. 2014

CEJU

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IntroductionThe repair of complex urethrorectal fistulas, which can be the result of treating prostate cancer with radical prostatectomy, is a big problem in urology and its final result is not always satisfactory. There are no universally accepted methods for repairing such fistulas. In our work we present a retrospective analysis of patients treated for urethrorectal fistulas after previous radical prostatectomy. The methods used were the initial excision and suture of the fistula, or a gracilis muscle flap interposition.Material and methodsIn the years 2000–2012, four patients were treated because of urethrorectal fistulas after radical prostatectomy. In two patients, open radical prostatectomy had been performed. Two other patients had been operated laparoscopically. Two patients had a primary fistula repair. They were operated using anterior perineal access. Two others were treated with the use of a gracilis muscle flap.ResultsDuring the follow up, there was no recurrence of fistulas. Medium follow up for the first two patients was 120 and 156 months, and follow up of two other patients was 16 and 23 months. Until now, there were no final postoperative complications.ConclusionsRepair of the fistulas requires an individual approach to each case. Excision and suturing of the fistula gives a very good final result, especially when the primary reconstruction is performed. Repair of urethrorectal fistula using a gracilis muscle flap appears to be an excellent option in cases of complex recurrent fistulas. It is also associated with low morbidity in patients and a high success rate.

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“…in patients with recurrent/persistent RUF, this cannot always be achieved, and therefore interposition of healthy tissue can be a solution. Many different surgical approaches using tissue interposition are reported (Table 3; [3,4,10,[13][14][15][16][17][18][19][20][21][22].…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic recto‐urethral fistula: perineal repair and buccal mucosa interposition

2008

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perineal fistula closed using a buccal mucosa graft interposition. The RUF had developed after laparoscopic or retropubic radical prostatectomy in four patients and after radical cystectomy and ileal neobladder in the fifth. Four of the patients had had at least one failed RUF repair before their referral to our institution. RESULTSFour of the five RUF were repaired successfully using the perineal approach and buccal mucosa graft interposition. Failure occurred in one patient who had developed a RUF after laparoscopic radical prostatectomy followed by two unsuccessful attempts at closure. The failure was most probably due to a previously undetected postoperative perineal haematoma with infection. CONCLUSIONOur perineal approach for repairing RUF, combined with buccal mucosa graft interposition, is a simple technique fulfilling all the requirements for successful fistula closure, especially in repeat surgery. OBJECTIVETo present a new and promising technique for repairing recto-urethral fistulae (RUF) using a perineal approach and buccal mucosa graft interposition, as RUF are rare but severe complications of rectal or urinary tract surgery, radiation treatment, trauma or inflammation, and the repair of recurrent or persistent RUF is particularly difficult when previous surgical attempts have failed, resulting in high recurrence rates. PATIENTS AND METHODSBetween 2004 and 2006, five men (aged 61-67 years) with iatrogenic RUF had the

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Surgical Treatment of Rectourethral Fistulae

Cited by 31 publications

References 11 publications

Rectal Advancement Flap Repair of Rectourethral Fistula

Rectal Advancement Flap Repair of Rectourethral Fistula

Treatment of urethrorectal fistulas caused by radical prostatectomy – two surgical techniques

Iatrogenic recto‐urethral fistula: perineal repair and buccal mucosa interposition

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