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Techniques in Coloproctology
Published in: Techniques in Coloproctology 9/2020

01-09-2020 | Prostate Cancer | Original Article

Surgical management of acquired rectourethral fistula: a retrospective analysis of 52 consecutive patients

Authors: G. Bislenghi, L. Verstraeten, I. Verlinden, F. Castiglione, K. Debaets, F. Van der Aa, S. Fieuws, A. Wolthuis, A. D’Hoore, S. Joniau

Published in: Techniques in Coloproctology | Issue 9/2020

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Abstract

Background

Acquired rectourethral fistula (RUF) is an uncommon complication mostly resulting from surgery or radiation. Standardization of the surgical management is lacking. The aim of this study was to report our experience with surgery for RUF.

Methods

This was a retrospective study of a prospectively maintained clinical database. The surgical strategy was tailored to complexity of RUF, presence of sepsis, history of radiation and residual urinary/fecal functionality. Outcomes measured were RUF closure and permanent fecal/urinary diversion. Impact of radiotherapy was also assessed.

Results

Between November 2002 and January 2019, 52 patients were identified (100% males). Median follow-up was 10.5 (0.5–16.8) years. Three patients had RUF closure after conservative management. The remaining 49 patients had a total of 76 procedures. The cumulative closure rate after the first, second and third attempt was 55.1%, 85.7% and 95.9%, respectively. Fistula closure together with preservation of the fecal and urinary function was achieved in 49%, 65.3% and 67.3% after the first, second and third repair, respectively. The overall success rate for transanal, transperineal, restorative transabdominal and non-restorative transabdominal procedures was 35.7%, 64.3%, 57.1% and 94.1%, respectively. A significantly higher rate of urinary/intestinal stomas was observed in the irradiated vs non-irradiated patients (84.2% vs 42.4%; p = 0.004).

Conclusions

Surgery ensured healing in 96% of the patients. Radiotherapy led to higher rate of permanent urinary/fecal diversion. Nearly all irradiated patients who had transabdominal repair end up with a definitive stoma. When transperineal repair with gracilis flap interposition was used, the rate of fistula closure approached 90%. A treatment algorithm is proposed.
Literature
1.
Gupta G, Kumar S, Kekre NS, Gopalakrishnan G (2008) Surgical management of rectourethral fistula. Urology 71(2):267–271CrossRef
2.
Ramirez-Martin D, Jara-Rascon J, Renedo-Villar T, Hernandez-Fernandez C, Lledo-Garcia E (2016) Rectourethral fistula management. Curr Urol Rep 17(3):22CrossRef
3.
Chrouser KL, Leibovich BC, Sweat SD, Larson DW, Davis BJ, Tran NV et al (2005) Urinary fistulas following external radiation or permanent brachytherapy for the treatment of prostate cancer. J Urol 173(6):1953–1957CrossRef
4.
Chen S, Gao R, Li H, Wang K (2018) Management of acquired rectourethral fistulas in adults. Asian J Urol 5(3):149–154CrossRef
5.
Hanna JM, Turley R, Castleberry A, Hopkins T, Peterson AC, Mantyh C et al (2014) Surgical management of complex rectourethral fistulas in irradiated and nonirradiated patients. Dis Colon Rectum 57(9):1105–1112CrossRef
6.
Keller DS, Aboseif SR, Lesser T, Abbass MA, Tsay AT, Abbas MA (2015) Algorithm-based multidisciplinary treatment approach for rectourethral fistula. Int J Colorectal Dis 30(5):631–638CrossRef
7.
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRef
8.
Hechenbleikner EM, Buckley JC, Wick EC (2013) Acquired rectourethral fistulas in adults: a systematic review of surgical repair techniques and outcomes. Dis Colon Rectum 56(3):374–383CrossRef
9.
Venkatesan K, Zacharakis E, Andrich DE, Mundy AR (2013) Conservative management of urorectal fistulae. Urology 81(6):1352–1356CrossRef
10.
Nyam DC, Pemberton JH (1999) Management of iatrogenic rectourethral fistula. Dis Colon Rectum. 42(8):994–997 (discussion 7-9)CrossRef
11.
Mundy AR, Andrich DE (2011) Urorectal fistulae following the treatment of prostate cancer. BJU Int 107(8):1298–1303CrossRef
12.
Ballek NK, Gonzalez CM (2013) Reconstruction of radiation-induced injuries of the lower urinary tract. Urol Clin North Am 40(3):407–419CrossRef
13.
Beddy D, Poskus T, Umbreit E, Larson DW, Elliott DS, Dozois EJ (2013) Impact of radiotherapy on surgical repair and outcome in patients with rectourethral fistula. Colorectal Dis 15(12):1515–1520CrossRef
14.
Larson DW, Chrouser K, Young-Fadok T, Nelson H (2005) Rectal complications after modern radiation for prostate cancer: a colorectal surgical challenge. J Gastrointest Surg 9(4):461–466CrossRef
15.
Marguet C, Raj GV, Brashears JH, Anscher MS, Ludwig K, Mouraviev V et al (2007) Rectourethral fistula after combination radiotherapy for prostate cancer. Urology 69(5):898–901CrossRef
16.
Moreira SG Jr, Seigne JD, Ordorica RC, Marcet J, Pow-Sang JM, Lockhart JL (2004) Devastating complications after brachytherapy in the treatment of prostate adenocarcinoma. BJU Int 93(1):31–35CrossRef
17.
Shakespeare D, Mitchell DM, Carey BM, Finan P, Henry AM, Ash D et al (2007) Recto-urethral fistula following brachytherapy for localized prostate cancer. Colorectal Dis 9(4):328–331CrossRef
18.
Lane BR, Stein DE, Remzi FH, Strong SA, Fazio VW, Angermeier KW (2006) Management of radiotherapy induced rectourethral fistula. J Urol. 175(4):1382–1387 (discussion 7-8)CrossRef
19.
Vanni AJ, Buckley JC, Zinman LN (2010) Management of surgical and radiation induced rectourethral fistulas with an interposition muscle flap and selective buccal mucosal onlay graft. J Urol 184(6):2400–2404CrossRef
20.
Atallah S, Albert M, Larach S (2010) Transanal minimally invasive surgery: a giant leap forward. Surg Endosc 24(9):2200–2205CrossRef
21.
Remzi FH, El Gazzaz G, Kiran RP, Kirat HT, Fazio VW (2009) Outcomes following Turnbull-Cutait abdominoperineal pull-through compared with coloanal anastomosis. Br J Surg 96(4):424–429CrossRef
22.
Ganio E, Martina S, Novelli E, Sandru R, Clerico G, Realis Luc A et al (2013) Transperineal repair with bulbocavernosus muscle interposition for recto-urethral fistula. Colorectal Dis 15(3):e138–e143CrossRef
Metadata
Title
Surgical management of acquired rectourethral fistula: a retrospective analysis of 52 consecutive patients
Authors
G. Bislenghi
L. Verstraeten
I. Verlinden
F. Castiglione
K. Debaets
F. Van der Aa
S. Fieuws
A. Wolthuis
A. D’Hoore
S. Joniau
Publication date
01-09-2020
Publisher
Springer International Publishing
Published in
Techniques in Coloproctology / Issue 9/2020
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI
https://doi.org/10.1007/s10151-020-02214-9

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