Coloanal Sleeve Anastomosis (Soave Procedure): The Ultimate Treatment Option for Complex Rectourinary Fistulas

Chirica, Mircea; Parc, Yann; Tiret, Emmanuel; Dehni, Nidal; McNamara, Deborah A.; Parc, R

doi:10.1007/s10350-006-0636-9

Cited by 22 publications

(10 citation statements)

References 16 publications

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“…for example, the soave procedure avoids dissection in the perirectal plane and allows the colon to reach the anal canal in a scarred pelvis, decreasing the risk of injury to the pelvic nerves, neighboring organs, and presacral veins. 13 although the use of a colonic J-pouch is the standard for low CRa or Caa, 38 56% of our patients received a straight anastomosis. this high rate can be explained by the length of the remaining colon, the narrowing of the pelvis secondary to sepsis and fibrosis, and the fear of leakage from the staple line of the pouch.…”

Section: Discussionmentioning

confidence: 98%

“…[18][19][20] aside from some publications with anecdotal cases of redo surgery, 13,21,22 our literature review found only 2 surgical teams to date that have reported their experience regarding reoperations for failed CRa or Caa, with a total of 60 patients. 7,12 moreover, one of these reports 7 was limited to patients undergoing anastomotic stricture repair.…”

Section: Discussionmentioning

confidence: 99%

“…10,11 for patients with anastomotic failure, redo surgery with construction of a new CRa or Caa may represent the only or last valuable option when all conservative treatments (endoscopic or surgical) have been attempted. 7,12,13 however, redo surgery is considered to be a surgical challenge, with important intraoperative technical difficulties and high related morbidity and failure rates, leading many surgeons to abandon this procedure in favour of a definitive stoma. 9 there are few data in the literature concerning redo surgery for failed CRa or Caa to help in decision making and answering questions and expectations from patients, although all digestive surgeons have been or will be confronted with such situations.…”

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confidence: 98%

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Postoperative and Long-term Outcomes After Redo Surgery for Failed Colorectal or Coloanal Anastomosis

Genser

Manceau

Karoui

et al. 2013

Diseases of the Colon &Amp; Rectum

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 98%

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Postoperative and Long-term Outcomes After Redo Surgery for Failed Colorectal or Coloanal Anastomosis

Genser

Manceau

Karoui

et al. 2013

Diseases of the Colon &Amp; Rectum

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“…For complex fi stulas, an abdominal-perineal approach involving left colon mobilization, limited rectal resection with colo-anal anastomosis (Soave procedure), and urethral repair has been described [5,9]. Another approach for complex fi stulas is to permanently divert either the urinary or fecal stream with repair of the salvaged organ [5].…”

Section: Expert Commentary: Dr Herschornmentioning

confidence: 99%

Urinary incontinence and pneumaturia: Management and treatment

Caruso

Gousse²

2009

Curr Urol Rep

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This case study involves a 63-year-old man with a chief complaint of urinary incontinence and pneumaturia. He was treated 2 years ago for prostate cancer with external beam radiation, and most recently with a salvage prostatectomy for local persistent prostate cancer. His symptoms began several weeks after the prostatectomy. He has no other chronic medical problems or past surgical history. His last screening colonoscopy demonstrated diverticulosis, and he has never been treated for diverticulitis. The patient reports frequent and copious passage of fl uid per rectum. He denies fecal incontinence. Figure 1 displays a representative image from a cystogram. What is the diagnosis? What is the next step in the management of this patient? If a surgical intervention is offered, when should it be done? What specifi c techniques should be used? How and when can the urinary incontinence be addressed? Expert Commentary: Drs. Crane and SantucciThe patient described has a constellation of symptoms worrisome for a colovesical fi stula. One must have a very high index of suspicion in a patient with a recent history of prostatectomy presenting with the combination of pneumaturia and passage of fl uid per rectum. Complicating factors include the history of radiation and diverticulitis. Urinary incontinence in the fi rst few months after a prostatectomy is not abnormal and would not necessarily raise concern. Cystogram is the defi nitive study to make the diagnosis; however, a cystoscopy with bilateral retrogrades also is indicated to rule out ureteral involvement and to fully understand the anatomy. Timing of repair is controversial. Most reconstructive urologists would not repair this until at least 6 weeks had passed from the last surgery. Many would wait much longer-at least 3 to 4 months. Some plastic surgeons with experience in this fi eld require at least 6 months before repair is contemplated.Once the diagnosis is made, the success of nonoperative treatments is dependent on the time course of fi stula occurrence and the size of the fi stula. If it is early and the fi stula is small, fulguration of the fi stula with urinary diversion via a suprapubic tube is worth a 6-week trial, although we admit that few fi stulas respond to this treatment. Because of the history of radiation, we believe this approach is even less likely to succeed. Also, a patient with a late fi stula occurrence has a lower probability of success. Scattered case reports on the use of fi brin glue on small colovesical and vesicovaginal fi stulae are found in the literature. In a review by Shekarriz and Stoller [1] on the use of fi brin sealants in urology, the authors commented that the results have been satisfactory. This is based, however, on a small number of case reports; therefore, general recommendations should be made, and treatments should be individualized. Our experience is that unless the fi stula is small in diameter and long enough to hold the fi brin glue plug in place, then fi brin sealants seldom work. We are also pessimistic about any co...

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“…Spontaneous healing of urethrorectal fistulas is rare, even after cutaneous fecal and urinary diversion (deviation of the colon and ureteres to skin). As a result, numerous surgical procedures have been described (MUNÕZ et al, 1998); however, none gained acceptance as a gold-standard in human medicine, and new procedures have still been described (CHIRICA et al, 2006).…”

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confidence: 99%

Radiographic diagnosis of traumatic urethrorectal fistula in dog

et al. 2011

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Coloanal Sleeve Anastomosis (Soave Procedure): The Ultimate Treatment Option for Complex Rectourinary Fistulas

Abstract: Soave procedure is an effective treatment for complex rectourinary fistula in the setting of high-dose pelvic radiation or after failed previous repair attempts.

Cited by 22 publications

References 16 publications

Postoperative and Long-term Outcomes After Redo Surgery for Failed Colorectal or Coloanal Anastomosis

Postoperative and Long-term Outcomes After Redo Surgery for Failed Colorectal or Coloanal Anastomosis

Urinary incontinence and pneumaturia: Management and treatment

Radiographic diagnosis of traumatic urethrorectal fistula in dog

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