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Surgery in Motion

Minimally Invasive Transanal Repair of Rectourethral Fistulas

By: Giulio Nicita , Donata Villari, Simone Caroassai Grisanti, Michele Marzocco, Vincenzo Li Marzi and Alberto Martini

European Urology, Volume 71 Issue 1, January 2017, Pages 133-138

Published online: 01 January 2017

Keywords: Fistula treatment, Laparoscopic instruments, Minimally invasive surgery, Transanal approach

Abstract Full Text Full Text PDF (803 KB)

Abstract

Background

Rectourethral fistulas (RUFs) represent an uncommon complication of pelvic surgery, especially radical prostatectomy. To date there is no standardised treatment for managing RUFs. This represents a challenge for surgeons, mainly because of the potential recurrence risk.

Objective

To describe our minimally invasive transanal repair (MITAR) of RUFs and to assess its safety and outcomes.

Design, setting, and participants

We retrospectively evaluated 12 patients who underwent MITAR of RUF at our centre from October 2008 to December 2014. Exclusion criteria were a fistula diameter greater than 1.5 cm, sepsis, and/or faecaluria.

Surgical procedure

After fistula identification through cystoscopy and 5F-catheter positioning within the fistula, MITAR is performed using laparoscopic instruments introduced through Parks’ anal retractor. The fibrotic margins of the fistula are carefully dissected by a lozenge incision of the rectal wall, parallel to the rectal axis. Under the healthy flap of the rectal wall the urothelium is located and the fistulous tract is sutured with interrupted stitches. After a leakage test of the bladder, the rectal wall is sutured with interrupted stitches. Electrocoagulation is never used during this procedure.

Measurements

Fistula closure, postoperative complications, and recurrence.

Results and limitations

Median follow-up was 21 (range, 12–74) mo. Median operative time was 58 (range, 50–70) min. Median hospital stay was 1.5 (range, 1–4) d. Early surgical complications occurred in one patient (8.3%). Recurrence did not occur in any of the cases. Limitations included retrospective analysis, small case load, and lack of experience with radiation-induced fustulas.

Conclusions

MITAR is a safe, effective, and reproducible procedure. Its advantages are low morbidity and quick recovery, and no need for a colostomy.

Patient summary

We studied the treatment of rectourethral fistulas. Our technique, transanally performed using laparoscopic instruments, was found to be safe, feasible, and effective, with limited risk of complications.

Take Home Message

We studied the treatment of rectourethral fistulas that had occurred after radical prostatectomy. Our minimally invasive technique, transanally performed using laparoscopic instruments, was found to be safe, feasible, and effective, with limited risk of complications.

Keywords: Fistula treatment, Laparoscopic instruments, Minimally invasive surgery, Transanal approach.

Footnotes

Department of Urology, University of Florence, Careggi Hospital, Florence, Italy

Corresponding author. Clinica Urologica II, Azienda Ospedaliera Careggi, Università di Firenze, Viale San Luca, Firenze 50134, Italy. Tel. +390557949218; fax: +390552758014.

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