Urorectal fistula repair using different approaches: operative results and quality of life issues

Abstract

Purpose: To evaluate efficacy of urorectal fistula (URF) repair using different approaches and the clinical factor determinant of success, and also the morbidity associated to the procedure and health-related quality of life (HRQoL) in male survivors of pelvic malignancies. Material and Methods: Retrospective evaluation of 39 patients with URF primarily intervened in three institutions using different surgical approaches. Success was defined as effective fistula closure. Variables evaluated included demographics, previous treatments, surgical approach, ancillary surgeries, complications and HRQoL by using a standardized nonvalidated specific questionnaire. Median follow-up from surgery to interview was 55 months (interquartile range 49, range 4-112). Factors determinant of success were investigated using logistic regression. Safety of the procedure was evaluated by Clavien-Dindo scale. Deterioration of continence and erectile function and other HRQoL issues were evaluated. Results: Prostate cancer treatment was the predominant etiology. The success rate for fistula repair was 89.5%. The surgical approach was not related to failed repair (p=0.35) or complications (p=0.29). Factors associated with failure were complications (p=0.025), radiotherapy (p=0.03), fistula location (p=0.04) and fistula size (p=0.007). Multivariate analysis revealed fistula size was the only independent determinant of failure (OR 6.904, 1.01-47.75). Complications occurred in 46.2% and severe complications in 12.8%. The mortality related to the procedure was 2.6%. Urinary incontinence was present before repair in 26.3% and erectile dysfunction in 89.5%. Fistula repair caused de novo urinary incontinence in 7.9% and deterioration of erectile status in 44.7%. Globally 79% were satisfied after repair and only 7.9% rated HRQoL as unhappy. Trans-sphincteric approach was related to less deterioration of erectile function (p=0.003), and higher perceived satisfaction in QoL (p=0.04). Conclusions: The surgical approach elected to correct URF is not determinant of success nor of complications. Fistula size appears as independent determinant for failure. Transsphincteric approach could be advantageous over other procedures regarding HRQoL issues.

Adverse Features of Rectourethral Fistula Requiring Extirpative Surgery and Permanent Dual Diversion: Our Experience and Recommendations

“…Vesicourethral and other pelvic complications resulting from pelvic tumor treatments have increased in the last decades, and a new classification for a standardized report of complications has been proposed [10,11]. Although apparently less invasive, non-surgical treatments have been associated with more complex, incapacitating and harder-to-treat complications [2].…”

Funktionsprotektiver Verschluss einer urethrokutanen Fistel der prostatischen Harnröhre über einen perinealen Zugang mit Gracilis-Flap

“…Es existieren unterschiedliche operative Strategien und Zugänge für die Sanierung von urethralen Fisteln (UF). In einem Review von Angulo et al über das operative Outcome und die postoperative Lebensqualität nach unterschiedlichen operativen Zugängen wurde gezeigt, dass es keine überlegene Operationstechnik gibt, und dass die operative Expertise und die lokale Situation die Technik bestimmen sollten [1]. Unser Fall stellt dahingehend eine Seltenheit dar, dass es sich um einen jungen und potenten Mann handelt und die Ätiologie der Fistel nicht evaluierbar zu sein scheint.…”