30 Years of Experience with York-mason Repair of Recto-Urinary Fistulas

Renschler, Todd; Middleton, Richard G.

doi:10.1097/01.ju.0000082013.58783.17

Cited by 118 publications

(91 citation statements)

References 12 publications

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“…11 Although we have used tissue interposition in a total of seven (50%) patients, six of them after some form of energy ablation (Group 1), we, like others, do not think it is crucial to use it in URF caused exclusively by surgery, where tissue injury is less significant and extensive (except for a previously failed URF repair). 12 Therefore, we do not recommend the routine and indiscriminate use of this adjuvant procedure, particularly in URF caused exclusively by surgical trauma; it should be used judiciously and with caution to avoid additional morbidity associated with these procedures.…”

Section: A B Cmentioning

confidence: 86%

“…1,[13][14][15][16] This issue has been described superficially, insufficiently, or even ignored, in most York-Mason literature. 6,11,17,18 Although popular between the 1960s and 1980s for the surgical treat- iatrogenic urorectal fistulae in men with pelvic cancer ment of small rectal cancers and adenomas, especially in an era where endoscopic excision of these lesions was nonexistent, 6,18-20 its popularity has recently been replaced by the transperineal approach by reconstructive surgeons, especially in high-volume centres. 9,12,21 In our series, an abdominoperineal approach was reserved for patients that were complicated by the development of a cavity in association with energy ablation, such as EBRT, BT, and HIFU.…”

Section: A B Cmentioning

confidence: 99%

“…Some authors have reported that preservation of potency, urinary incontinence, and rectal innervation is possible after the York-Mason operation because it avoids dissection in the lateral pelvic and pararectal space. 11 We believe that in most URF patients, these complications result primarily from the oncological treatments that cause the fistula rather than the surgical repair.…”

Section: A B Cmentioning

confidence: 99%

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Management of iatrogenic urorectal fistulae in men with pelvic cancer

Martins¹,

Martins²,

Pinheiro³

et al. 2017

CUAJ

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Introduction: Urorectal fistula (URF) is a devastating complication of pelvic cancer treatments and a surgical challenge for the reconstructive surgeon. We report a series of male patients with URF resulting from pelvic cancer treatments, specifically prostate (PCa), bladder (BCa), and rectal cancer (RCa), and explore the differences and impact on outcomes between purely surgical and non-surgical treatment modalities. Methods: Between October 2008 and June 2015, 15 male patients, aged 59-78 years (mean 67), with URF induced by pelvic cancer treatments were identified in our institutions. Patients with a history of diverticulitis, inflammatory bowel disease, or other benign conditions were excluded. We reviewed the patients' medical records for symptoms, diagnostic tests performed, type and etiology of the fistula, type of surgical reconstruction, followup, and outcomes. Results: Fourteen patients underwent surgical reconstruction. One patient developed metastatic disease before URF repair and, therefore, was excluded from this study. Mean followup (FU) was 32.7 months (14-79). All patients received diverting colostomy and temporary urinary diversion. An exclusively transperineal approach was used in nine (64.3%) patients and a combined abdominoperineal in five (35.7%). Overall successful URF closure was achieved in 12 (85.7%) patients, nine (64.3%) of whom at the first reconstructive attempt, two (14.3%) after two attempts (in our institution), and one (7.1%) after three attempts (two of which elsewhere). An interposition flap was used in seven (50%) patients. Surgical reconstruction failed ultimately in two (14.3%) patients who still have a colostomy and do not wish any further reconstruction. Conclusions: Our study has several limitations, including its retrospective nature and the heterogeneity of our small patient cohort. Nonetheless, although surgical reconstruction of URF may be extremely difficult and complex in the non-surgical/energy ablation patients, its successful reconstruction is possible in most through a transperineal, or a more aggressive abdominoperineal, approach with tissue interposition in selected patients.

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Section: A B Cmentioning

confidence: 86%

Section: A B Cmentioning

confidence: 99%

Section: A B Cmentioning

confidence: 99%

See 1 more Smart Citation

Management of iatrogenic urorectal fistulae in men with pelvic cancer

Martins¹,

Martins²,

Pinheiro³

et al. 2017

CUAJ

View full text Add to dashboard Cite

show abstract

“…16 Preservation of potency, urinary continence, and rectal innervation is possible because the lateral pelvic and pararectal space is avoided. However, exposure of the bulbar and membranous urethra is difficult.…”

Section: Discussionmentioning

confidence: 99%

Transperineal approach to complex rectourinary fistulae

Tran

Flannigan

Rapoport

2015

CUAJ

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Introduction: We sought to present our experience and outcomes in patients with complex rectourethral fistulae (RUF) treated using the transperineal approach with gracilis muscle flap interposition. Complex RUF was defined as having prior radiation, failed repair attempts, and large size (>2 cm).Methods: A retrospective review identified 10 patients presenting with complex RUF between July 2009 and November 2013. Three were excluded due to large fistula defects managed with urinary diversion. Seven patients met inclusion criteria and underwent reconstruction.Results: Six of 7 patients had prostate cancer, and one patient had colon cancer treated with low anterior resection with adjuvant radiation. The primary modality of prostate cancer therapy was brachytherapy (n=3), external beam radiotherapy (n=2) and radical retropubic prostatectomy (RRP) (n=1). Three patients had salvage cancer therapy, including RRP (n=1), cystoprostatectomy with ileal conduit (n=1), and cryotherapy (n=1). One patient developed RUF post-primary RRP without radiation. Mean fistula size was 2.8cm (2‒4 cm). No fistulas recurred at mean follow-up 11.4 months (6‒20 months). Three patients have had colostomy reversal, one is pending reversal and three have permanent colostomies. Five patients have stress urinary incontinence, with two managed with one to four pads per day, one managed with a condom catheter, and two waiting for artificial urinary sphincter (AUS). One patient developed a perineal wound infection and one developed a pulmonary embolus treated medically.Conclusion: Complex RUF defects are effectively treated with transperineal repair using gracilis muscle interposition. The procedure has low morbidity and high success. Concomitant stress incontinence and bladder outlet contracture are prevalent in this population and may require ongoing management.

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“…Un patient avait besoin d'une reprise par la procédure de York-Mason et un autre a subi une reprise par voie périnéale pour corriger une récidive 22 . Aucune incontinence fécale n'a été observée après la procédure de YorkMason dans notre étude, ce qui concorde avec les séries précédemment rapportées 23 .…”

Section: Cuaj • August 2012 • Volume 6 Issue 4 E158unclassified

Technique de York-Mason dans le traitement des fistules

Nouri

Yacoubi

Daoudi

et al. 2013

CUAJ

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Les fistules urétro-prostato-rectales ou prostato-rectales sontrares, et le plus souvent secondaires à une interventionchirurgicale. L’emplacement profond de ces fistules expliquela difficulté de l’accès chirurgical et, par conséquent,la multiplicité des voies d’abord décrites pour les traiter. Lavoie trans-ano-sphinctérienne décrite par York-Mason offreun bon accès et n’expose à aucune complication quand sesrègles sont respectées.Dans notre étude, nous présenterons 3 cas opérés entre1996 et 2009 par la voie transanorectale et trans-sphinctériennede York-Mason, en comparant cette voie avec lesautres décrites; nous préciserons ses avantages et ses indications.

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30 Years of Experience with York-mason Repair of Recto-Urinary Fistulas

Cited by 118 publications

References 12 publications

Management of iatrogenic urorectal fistulae in men with pelvic cancer

Management of iatrogenic urorectal fistulae in men with pelvic cancer

Transperineal approach to complex rectourinary fistulae

Technique de York-Mason dans le traitement des fistules

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