Management of Surgical and Radiation Induced Rectourethral Fistulas With an Interposition Muscle Flap and Selective Buccal Mucosal Onlay Graft

Vanni, Alex J.; Buckley, Jill C.; Zinman, Leonard

doi:10.1016/j.juro.2010.08.004

Cited by 98 publications

(58 citation statements)

References 17 publications

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“…In our series a single investigator performed this in patients who underwent energy ablation. 12 Concomitant bladder neck contracture or urethral stricture was more common in the energy ablative cohort (26.0% vs 14.2% of cases, p ¼ 0.03).…”

Section: Resultsmentioning

confidence: 89%

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Rectourethral Fistulas Secondary to Prostate Cancer Treatment: Management and Outcomes from a Multi-Institutional Combined Experience

Harris¹,

McAninch²,

Mundy³

et al. 2017

Journal of Urology

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Purpose: Rectourethral fistula is a known complication of prostate cancer treatment. Reports in the literature on rectourethral fistula repair technique and outcomes are limited to single institution series. We examined the variations in technique and outcomes of rectourethral fistula repair in a multi-institutional setting. Materials and Methods: We retrospectively identified patients who underwent rectourethral fistula repair after prostate cancer treatment at 1 of 4 large volume reconstructive urology centers, including University of California-San Francisco, University College London Hospitals, Lahey Clinic and Devine-Jordan Center for Reconstructive Surgery, in a 15-year period. We examined the types of prostate cancer treatment, technical aspects of rectourethral fistula repair and outcomes. Results: After prostate cancer treatment 201 patients underwent rectourethral fistula repair. The fistula developed in 97 men (48.2%) after radical prostatectomy alone and in 104 (51.8%) who received a form of energy ablation. In the ablation group 84% of patients underwent bowel diversion before rectourethral fistula repair compared to 65% in the prostatectomy group. An interposition flap or graft was placed in 91% and 92% of the 2 groups, respectively. Concomitant bladder neck contracture or urethral stricture developed in 26% of patients in the ablation group and in 14% in the prostatectomy group. Postoperatively the rates of urinary incontinence and complications were higher in the energy ablation group at 35% and 25% vs 16% and 11%, respectively. The ultimate success rate of fistula repair in the energy ablation and radical prostatectomy groups was 87% and 99% with 92% overall success. Conclusions: Rectourethral fistulas due to prostate cancer therapy can be reconstructed successfully in a high percent of patients. This avoids permanent urinary diversion in these complex cases.

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Section: Resultsmentioning

confidence: 89%

“…6,10,12 We discuss the management and combined outcomes of RUF after prostate cancer treatment at 4 reconstructive urology centers where there is experience with managing these cases.…”

mentioning

confidence: 99%

Rectourethral Fistulas Secondary to Prostate Cancer Treatment: Management and Outcomes from a Multi-Institutional Combined Experience

Harris¹,

McAninch²,

Mundy³

et al. 2017

Journal of Urology

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“…Although it is impossible to conclude much due to the small case numbers in this study, we also should pay attention to urinary incontinence after transperineal repair for URF because there is a risk of sphincter impairment. Urethral catheters were maintained for a median duration of 2 months post operation; this duration was slightly longer than that in other studies [5,10] . Based on the existing situation, these periods are determined differently in each of the institutions.…”

Section: Discussionmentioning

confidence: 84%

“…Several possible factors affecting results of URF repair have been reported [5,[8][9][10] . Some papers suggested that complicated fistulas with a large diameter, previous failed repair surgery, or previous irradiation are negative predictive factors for the successful closure of fistulas.…”

Section: Discussionmentioning

confidence: 99%

Analysis of a Surgical Treatment for Persistent Urorectal Fistulas after Radical Cancer Surgery: A Comparison of Prostate Cancer and Rectal Cancer

Sakai¹,

Komai²,

Saitô

et al. 2017

Urol Int

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Introduction: The study aimed to present our experience of surgical treatment for urorectal fistulas (URF) that develop after cancer surgery. Materials and Methods: Fourteen patients with URF who were treated at our institution from 2005 through 2015 were retrospectively analyzed. Among these, 7 patients had previous surgical treatment of prostate cancer (PC) and the other 7 had been treated for rectal cancer (RC). The fistula was resected through a perineal incision, and the urinary and fecal defects were separately closed with the hinge flap method followed by interposition of a muscle flap transfer. Results: The overall fistula closure rate was 79%. Although the closure rate of the URF was lower in patients with previous RC surgery compared to the PC patients (57 vs. 100%), it did not reach statistical significance. Conclusions: URF treatment using an interposition muscle flap offers a high success rate of fistula closure. However, complicated fistulas occurring after RC surgery involving the prostate or the seminal vesicle might be difficult to repair by this surgery alone.

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“…Komplizierend hierbei sind häufig gleichzeitig bestehende urethrale Strikturen. Vanni et al[35] berichten in einem Kollektiv von 39 Patienten über eine Erfolgsquote von 84% bei Anwendung eines perinealen Zugangswegs mit Fistelverschluss und Interposition eines M.-gracilis-Lappens bei einem Follow-up von median 20 Monaten. Bemerkenswert hierbei ist ein Anteil von 28% an Patienten mit simultan bestehender Urethrastriktur, die mit einem Mundschleimhautpatch in Onlay-Technik versorgt wurde.…”

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Therapie von Strahlenspätschäden am Harntrakt

Kocot

Riedmiller

2015

Urologe

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Management of Surgical and Radiation Induced Rectourethral Fistulas With an Interposition Muscle Flap and Selective Buccal Mucosal Onlay Graft

Cited by 98 publications

References 17 publications

Rectourethral Fistulas Secondary to Prostate Cancer Treatment: Management and Outcomes from a Multi-Institutional Combined Experience

Rectourethral Fistulas Secondary to Prostate Cancer Treatment: Management and Outcomes from a Multi-Institutional Combined Experience

Analysis of a Surgical Treatment for Persistent Urorectal Fistulas after Radical Cancer Surgery: A Comparison of Prostate Cancer and Rectal Cancer

Therapie von Strahlenspätschäden am Harntrakt

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