Anterior transanal, transsphincteric sagittal approach for fistula repair secondary to laparoscopic radical prostatectomy: A simple and effective technique

Castillo, Octavio A.; Bodden, Elias; Vitagliano, Gonzálo; Gómez, R.

doi:10.1016/j.urology.2006.04.002

Cited by 27 publications

(13 citation statements)

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“…Minimally invasive perineal approaches can be used such as ASTRA, which allows fistula resection and adequate closure (18,19). This approach was first described by Gecelter (18) in 1973 and reproduced at our institution only changing the forced lithotomy position for a jack-knife position (20).…”

Section: Discussionmentioning

confidence: 99%

Management of rectal injury during laparoscopic radical prostatectomy

2006

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Purpose: Because laparoscopic radical prostatectomy remains a challenging procedure, rectal injury is always a potential complication. We review the incidence of rectal injuries at our institution in the first 110 consecutive laparoscopic extraperitoneal radical prostatectomies. Materials and Methods: Nine (8%) out of the first 110 laparoscopic extraperitoneal radical prostatectomies performed between December 2001 and February 2004, were complicated by rectal injury. Mean patient age was 64.9 years (range 52 to 74) and mean prostate specific antigen was 11.45 ng/mL (range 4.8 to 37.4). Median preoperative Gleason score was 6 (range 4 to 8) and clinical stage was T1c, T2a, T2b in 6, 2 and 1 patient, respectively. Mean operative time was 228 minutes (range 150 to 300). Results: From 9 injuries, 6 were diagnosed and repaired intraoperatively and 3 were diagnosed postoperatively. From the 6 cases of intraoperative diagnosis and repair, 3 patients healed primarily without colostomy and a recto-urinary fistula was evidenced by pneumaturia in the remaining three. These 3 patients were managed conservatively with urethral catheterization during 30 days. One of the patients required secondary fistula repair by anterior transphincteric, transanal surgical approach (ASTRA). Urinary fistula was diagnosed postoperatively on 3 patients. A diverting colostomy was performed on one patient with secondary fistula repair by ASTRA. Another patient required laparotomy due to peritonitis and urinary fistula was later managed with ASTRA. On the third patient conservative management with urethral catheter was successful. All fistulas repaired with ASTRA evolved uneventfully. There was no perioperative mortality. Conclusions: Rectal injury during laparoscopic radical prostatectomy can be managed intraoperatively or by a minimally invasive procedure without the need of colostomy. Laparoscopic radical prostatectomy is a challenging procedure and is associated with a very flat learning curve; the incidence of rectal injuries is prone to diminish with experience.

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Section: Discussionmentioning

confidence: 99%

Management of rectal injury during laparoscopic radical prostatectomy

2006

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“…Different types of complications have been reported in up to 35% of the cases, but most of them have negligible clinical consequences (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Mortality has reported to be approximately from 0.5 to 1%, and has been related to heart diseases or cases of pulmonary embolism.…”

Section: Commentsmentioning

confidence: 99%

“…Rectal injuries are potential complications of radical prostatectomy, with rates between 0 and 9% being described in LRP series (15,18). These injuries often occur at the end of the excision of the prostate gland, or during the dissection of the lateral pedicles or while sectioning the rectourethralis muscle adjacent to the prostatic apex.…”

Section: Commentsmentioning

confidence: 99%

Laparoscopic radical prostatectomy: 10 years experience

et al. 2009

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Purpose:The authors assess the morbidity, functional results and oncologic follow-up of a series of laparoscopic radical prostatectomies performed in over a 10-year period. Materials and Methods:The data on 780 laparoscopic radical prostatectomies performed between September 1997 and December 2007 were stored in a personal database. The following parameters are described and critically analyzed: operative time, blood transfusions, conversions, length of hospital stay, complications, functional results of sexual potency and urinary continence, surgical margins and oncologic follow-up. Results: Operative time averaged 125 minutes, with a mean bleeding volume of 335 mL and mean hospital stay of 4.3 days. The rate of conversion to open surgery was 1.36% and the overall complication rate was 14.24%. The pathology analysis showed pT2 tumors in 82.60% and pT3 tumors in 17.39% of cases. The overall positive margin rate was 19.58%, with a biochemical recurrence of 10.27% at a mean follow-up of 62.5 months. Urinary continence and sexual potency yielded rates of 88% and 61%, respectively, 12 months after surgery. Conclusions: Laparoscopic radical prostatectomy is a technically well-defined procedure that provides good oncologic and functional results after proper training.

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“…Fistula repair was successful in all patients without fecal incontinence or anal strictures. Therefore, the authors affirm that this method is reproducible even in inexperienced hands [14].…”

Section: Discussionmentioning

confidence: 53%