Minimally Invasive Transanal Repair of Rectourethral Fistulas

详细信息    查看全文

• 作者：Giulio Nicita ; ^{gnicita@unifi.it} ; Donata Villari ; Simone Caroassai Grisanti ; Michele Marzocco ; Vincenzo Li Marzi ; Alberto Martini
• 关键词：Fistula treatment ; Laparoscopic instruments ; Minimally invasive surgery ; Transanal approach
• 刊名：European Urology
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：71
• 期：1
• 页码：133-138
• 全文大小：803 K
• 卷排序：71

文摘

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.ObjectiveTo describe our minimally invasive transanal repair (MITAR) of RUFs and to assess its safety and outcomes.Design, setting, and participantsWe 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 procedureAfter 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.MeasurementsFistula closure, postoperative complications, and recurrence.Results and limitationsMedian 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.ConclusionsMITAR is a safe, effective, and reproducible procedure. Its advantages are low morbidity and quick recovery, and no need for a colostomy.Patient summaryWe 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.