Vacuum-aspiration system in the treatment of urethrorectal fistula after laparoscopic radical prostatectomy

Abstract

Prevailing complications of radical prostatectomy include rectal injuries and urethrorectal fistulas. Their surgical treatment is highly invasive with 25% recurrence rate. The most commonly used techniques include the York-Mason procedure and transperineal fistuloplasty using local tissue or gracilis muscle flap of thigh. In addition, endoscopic vacuum-aspiration therapy has been used to treat failed anastomoses of digestive tract since 2006. The therapy involves continuous active aspiration through a monoporous foam material of the required size fixed to the aspiration tube. The paper presents a clinical case of successful treatment of urethrorectal fistula by means of a vacuum-aspiration system, which enables the fistula to be completely separated and urethral and anal continence to be preserved. On the 45th day after radical prostatectomy, the cystoscopy and rectoromanoscopy detected closure of the defect; independent urination was restored. 6 months later, independent defecation came back. Relapse-free period for the underlying disease and its complications comprised 32 months.