No abstract
Background Rectourethral fistula (RUF) is an uncommon serious condition with various etiologies including neoplasm, radiation therapy, and surgery. Treatment for RUF remains problematic with a high recurrence rate. Although studies have suggested the recurrence rate of RUF is lower after surgical repair using a gracilis flap, outcomes have varied and the studies were small and inadequately controlled. Here, we compare outcomes of RUF repair with and without gracilis flap to evaluate its efficacy in preventing fistula recurrence and identify risk factors for recurrence. Methods We retrospectively reviewed patients who had undergone surgical repair for RUF between 2007 and 2018 at our institution and had at least 30 days of follow-up. Patient demographics, comorbidities, and surgical outcomes were recorded and compared for patients who had gracilis flap repair and those who did not (controls). Single variable logistic regression analysis was used to identify risk factors for recurrence. Results The gracilis group (n = 24) and control group (n = 12) had similar demographics and comorbidities. Fistula recurrence was far less frequent in the gracilis group (8% vs 50%, P = 0.009). There were no significant differences in other outcomes including length of hospitalization and surgical complications. When recurrent RUF was treated with a muscle flap (gracilis or inferior gluteus), 83% of the group had no additional fistula recurrence. In the control group, history of radiation (P = 0.04) and urinary incontinence (P = 0.015) were associated with fistula recurrence. Conclusions We recommend using a gracilis flap for RUF repair given its association with lower recurrence without increased surgical complications.
INTRODUCTION AND OBJECTIVES:Little is known about the rates and characteristics of perioperative complications after incontinence surgery in men. We sought to bridge this knowledge gap by evaluating complications after the treatment of male urinary incontinence using a prospectively maintained, risk adjusted and nationally validated outcomes-based program.METHODS: This is an analysis of data prospectively obtained from academic and community medical centers through the American College of Surgeons National Surgery Quality Improvement Program (ACS-NSQIP). The study population consists of patients who underwent male urethral sling (CPT 53440) or artificial urinary sphincter (AUS-CPT 53445) placement between 2011 e 2013. The primary outcome was a composite 30eday major morbidity measure that included unplanned readmission related to the procedure, unplanned return to the operating room related to the procedure, infection, deep venous thrombosis or pulmonary embolism, pneumonia, or acute renal failure.RESULTS: 789 male patients underwent anti-incontinence procedures during the study period, which included 370 slings, and 419 AUS. There were no perioperative deaths, no cerebrovascular or cardiovascular complications, and no transfusions required. Unplanned readmissions and unplanned return to the operating room made up the majority of morbidity (see Table ). Major morbidity was higher in AUS group than sling group (5.5% vs. 2.4%, p¼.031), including higher related unplanned readmissions (3.8% vs. 1.4%, p¼.044) and related unplanned return to the operating room (1.7% vs. 0.0%, p¼.016).Octogenarians comprised 9.5% of patients (75/789) and had more than twice the major morbidity rate (8.0%) than less elderly patients (3.8%). This difference, however, was not found to be statistically significant (p ¼ .118).CONCLUSIONS: In a multicenter prospectively maintained cohort of men who underwent incontinence surgery, major morbidity was infrequent, and was slightly higher after AUS placement as compared to sling placement. Octogenarians' overall complication rate was low, with no mortality or severe cardiovascular morbidity. Male slings and AUS are safe operations with few perioperative complications, even in elderly patients.
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