Rectourethral Fistula: Systemic Review of and Experiences With Various Surgical Treatment Methods

Choi, Ji Hye; Jeon, Byeong Geon; Choi, Sang-Gi; Han, Eon Chul; Ha, Heon-Kyun; Oh, Heung‐Kwon; Choe, Eun Kyung; Moon, Sang Hui; Ryoo, Sungwoo; Park, Kyu Joo

doi:10.3393/ac.2014.30.1.35

Cited by 55 publications

(43 citation statements)

References 31 publications

(37 reference statements)

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“…Considering the healing of the local scar tissue, the gracilis muscle or the rectal wall after removing the mucosa has often been used to separate the urethra and the rectum. [7][8][9] In the present study, the patients' first surgery was usually perineal anoplasty, and the scar tissue encountered in this surgery was restricted to the anal opening, with little residual scarring around the fistula, especially around the urethral opening of the fistula. Therefore, the filling tissue for the pediatric patients in this study was mostly the local deep transverse perineal muscle and the urethral sphincter near the fistula, along with the levator ani muscles (pubococcygeal muscle).…”

Section: Discussionmentioning

confidence: 70%

Treatment Efficacy of Different Surgical Procedures for Postoperative Residual Rectourethral Fistula Following Anoplasty

Zhang

Chen

Pang

et al. 2017

International Surgery

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Background/Purpose: This study summarizes the surgical treatment options and their clinical efficacy for postoperative residual rectourethral fistula following anoplasty in patients treated in our department from July 2005 to July 2012.Methods: For 38 cases of postoperative residual rectourethral fistula following anoplasty, according to differences in anal appearance and functionality, either an anterior sagittal or a posterior sagittal surgical rectourethral fistula repair procedure was performed.Results: The residual rectourethral fistula following anoplasty was an obvious tube-like structure with a length of 0.9 6 0.4 cm. Healing after the 1-stage operation was achieved in 37 cases. Among these cases, 35 were followed up and showed no urethral stricture and no diverticulum. The clinical score for anal function was excellent in 31 cases and good in 4 cases, with significant differences compared with the scores before surgery (P , 0.05). The respective operative times for the 2 surgical procedures were 74.6 6 10.1 minutes and 105.6 6 14.6 minutes (P , 0.05). Conclusions:The appropriate choice of surgical procedure was dependent on the patients' anal appearance and functionality. Posterior sagittal anorectoplasty was suitable in cases with a severely disordered perineal appearance, and it was a relatively difficult operation. In contrast, anterior sagittal anorectoplasty was best applied in patients with minor alteration in perineal appearance, and it had a clear surgical field and was easy to perform. In this study, the repair of cases of residual rectourethral fistula following anoplasty using anterior sagittal or posterior sagittal anorectoplasty showed high success rates, and anal function was significantly improved.

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Section: Discussionmentioning

confidence: 70%

Treatment Efficacy of Different Surgical Procedures for Postoperative Residual Rectourethral Fistula Following Anoplasty

Zhang

Chen

Pang

et al. 2017

International Surgery

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“…Also, there is a recognized problem with fecal incontinence and, therefore, the procedure should be avoided in those with severe radiation proctitis. 12 The transsphincteric approach cannot be used for large, complex fistulas due to limited exposure. 15 The transabdominal approach is rarely used due to the deep pelvic dissection required, although it has been used in some patients with severe radiation damage requiring extensive resection and permanent diversions.…”

Section: Discussionmentioning

confidence: 99%

“…Different surgical approaches described include transanal, transsphincteric, and transabdominal; however, there is no general consensus regarding optimal treatment. 12 We present our local case series of patients presenting with complex RUF treated using the transperineal approach with gracilis muscle flap interposition.…”

Section: Introductionmentioning

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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“…3,4 Therefore, failure of conservative treatment mandates surgical intervention. Several techniques have been employed for decades to treat URF, including transperineal, abdominoperineal, trans-ano-rectal Francisco E. Martins, MD 1,2 ; Natália M. Martins (Parks), posterior transsacral (Kraske), and variants; 1,[5][6][7][8] however, despite all these reported surgical possibilities, the single "best" procedure is still a topic of intense debate.…”

Section: Introductionmentioning

confidence: 99%

“…2 The post-surgical URF patients are relatively easy to treat, with rapid recovery and return to daily routine activities. In contrast, URF patients following non-surgical treatments are more problematic and have a much slower return to a more compromised level of daily activities and overall recovery.…”

Section: Introductionmentioning

confidence: 99%

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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Rectourethral Fistula: Systemic Review of and Experiences With Various Surgical Treatment Methods

Cited by 55 publications

References 31 publications

Treatment Efficacy of Different Surgical Procedures for Postoperative Residual Rectourethral Fistula Following Anoplasty

Treatment Efficacy of Different Surgical Procedures for Postoperative Residual Rectourethral Fistula Following Anoplasty

Transperineal approach to complex rectourinary fistulae

Management of iatrogenic urorectal fistulae in men with pelvic cancer

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