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

Abstract

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.

Single Running Suture versus Single-Knot Running Suture for Vesicourethral Anastomosis in Laparoscopic Radical Prostatectomy: A Prospective Randomised Comparative Study

“…This feature enables the fashioning of the VUA in a watertight fashion, a step which remains a challenging and time-consuming part of the operation. Postoperative VUA leakage is one of the most bothersome complications of radical prostatectomy, as it may result in poor anastomosis healing, urethral stricture, urinoma as well as abscess formation [3,5,6]. In an attempt to simplify this critical step of LRP, several authors have proposed different techniques for the VUA [7,8,9,10,11,16].…”

“…VUA leakage is also one of the most important risk factors for postoperative urinary incontinence [4]. In addition, anastomotic urinary leakage and bladder neck strictures may result in urinary retention, pelvic abscess and a delayed return of continence, complications which commonly necessitate secondary procedures [3,5,6]. In the quest for an optimal VUA, several modifications have been previously described including interrupted and running sutures [7,8,9,10,11].…”

Vacuum-aspiration system in the treatment of urethrorectal fistula after laparoscopic radical prostatectomy

“…В этом случае используются различные виды доступа: трансанальный, транссфинктерный, абдоминальный и промежностный [4]. При этом пластика проводится преимущественно местными тканями или тонкой мышцей бедра [5,6]. Описаны случаи успешного лечения уретроректальных свищей с применением более редких доступов и методик, таких как иссечение и ушивание непрерывным швом везикоскопическим доступом, применение фибринового клея, фульгурация свищевого хода, трансперинеальная пластика с применением свиного кожного трансплантата, пластика лоскутом мошонки, слизистой щеки, фрагментом большого сальника [6].…”