236 EXPERIENCE WITH RECTOURETHRAL FISTULA REPAIR AND DESCRIPTION OF A NOVEL SURGICAL TECHNIQUE

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery III1 Apr 2012236 EXPERIENCE WITH RECTOURETHRAL FISTULA REPAIR AND DESCRIPTION OF A NOVEL SURGICAL TECHNIQUE Ashley Cox, Paul Toren, and Sender Herschorn Ashley CoxAshley Cox Toronto, Canada More articles by this author , Paul TorenPaul Toren Toronto, Canada More articles by this author , and Sender HerschornSender Herschorn Toronto, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.291AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Rectourethral fistula (RUF) is a rare complication following treatment of prostatic or rectal pathology. Many of the cases require surgical repair including fecal and urinary diversion. We report our experience with several surgical techniques including a novel abdominal approach to the repair of RUF. METHODS The records of all RUF treated at our institution were reviewed. Patient demographics, fistula etiology, method of fecal diversion, details of surgical treatment and urological outcomes were recorded and analyzed using Visual dBase 5.7. The decision regarding surgical technique for RUF repair was made on an individual basis and is shown in the Table. Six patients underwent an abdominal repair that involved either radical prostatectomy or takedown of the vesico-urethral anastomosis, direct closure of the rectal defect with tissue interposition, and anastomosis or reanastomosis of the bladder and urethra. Transanal York-Mason Transperineal Abdominal Etiology +Prostatectomy Redo vesicourethral anastomosis N 3 7 2 4 2 Prostatectomy +/- DVIU⁎⁎ 3 7 1 Radiation/HIFU⁎ 1 2 Rectal surgery 1 2 1 ⁎ high intensity focused ultrasound. ⁎⁎ direct vision urethrotomy. RESULTS Eighteen patients underwent repair of a RUF. Mean age was 65.6 years (range 45.9-85.7). Mean follow-up after repair was 41.3 months (range 1-293). RUF etiology included: radical prostatectomy (12), endoscopic management of bladder neck contrature (4), brachytherapy (2), external beam radiotherapy (2), HIFU (1), low anterior rectal resection (1), anal atresia (1), and anal trauma (1). Seven patients had multiple therapies causing the fistula and 2 had coexistent inflammatory bowel disease. Seventeen had fecal diversion (6 colostomy, 11 ileostomy), usually performed prior to the RUF repair. The mean time to diversion reversal was 8.8 months (range 4.2- 12.1) following RUF repair. Post-operatively, 2 patients developed bladder neck contractures requiring urethrotomy and 3 patients underwent successful incontinence procedures (2 artificial urinary sphincters and 1 Argus sling). To date there has been no RUF recurrence. CONCLUSIONS RUF is associated with multiple causative factors. An individualized approach to repair affords a good outcome. Temporary fecal diversion is helpful in many cases. A new abdominal approach involving either prostatectomy or take-down and redoing of the vesico-urethral anastomosis can be associated with a successful outcome. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e97 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ashley Cox Toronto, Canada More articles by this author Paul Toren Toronto, Canada More articles by this author Sender Herschorn Toronto, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.