York Mason Procedure to Repair Iatrogenic Rectourinary Fistula: Our Experience

Falavolti, Cristina; Sergi, Federico; Shehu, Ervin; Buscarini, Maurizio

doi:10.1007/s00268-013-2199-y

Cited by 22 publications

(15 citation statements)

References 53 publications

(31 reference statements)

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“…RVF are uncommon entities with a variety of different etiologies, including inflammatory diseases, pelvic malignancy, or as consequence of iatrogenic injury or radiotherapy. 1,2 Optimal surgical management for RVF is dependent on the underlying pathology report, site of the lesion, and preoperative status of the patient. Both open and laparoscopic procedures can be used for treatment with the goal of the operation being to resect and reanastomose the diseased bowel segment and close the bladder.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

“…1 The York Mason posterior trans-sphincteric repair is another feasible and effective surgical approach that allows for excellent exposure of the fistulous tract and the possibility of avoiding fecal diversion. 2 More recently, other less invasive endoscopic modalities have become potential alternatives of formal abdominal repair. The over-the-scope clip (OTSC) system is one such endoscopic approach with investigation occurring on the endoscopic closure of GI fistulae, including RVF.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

“…1 RVF most commonly result from inflammatory conditions, including diverticulitis or Crohn's disease, advanced malignancies, and as complications after pelvic surgery. 1,2 RVF should be suspected in patients with pneumaturia or fecaluria, especially in the postoperative setting. Surgery is currently the gold standard for managing RVF, but recent advances in endoscopic therapy have provided new options.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic Closure of a Large Rectovesical Fistula Following Robotic Prostatectomy

Watts

Kocher

Pauli

et al. 2020

Journal of Endourology Case Reports

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Background: Rectovesical fistulae (RVF) are uncommon complications of pelvic surgeries and are a potential cause of significant morbidity. RVF are not typically closed endoscopically but rather require reoperative surgery of the lower pelvis with closure of tract, interposition of fat or omentum, and possible permanent bowel diversion. We present a unique case of a rectovesical fistula developing after robotic prostatectomy that was managed by multimodal multistage endoscopic therapy as an alternative to conventional operative repair. Case Presentation: A healthy 78-year-old Caucasian man underwent a robot-assisted laparoscopic radical prostatectomy with bilateral pelvic lymph node dissection for high-risk adenocarcinoma of the prostate. The patient's postoperative course was complicated by an unrecognized rectal injury culminating in emergent exploration, abdominal washout, creation of a diverting loop transverse colostomy, and resultant development of a large rectovesical fistula. Given the patient's hostile abdomen and desire for conservative management the fistula was managed through a combined cystoscopic and endoscopic procedure that utilized suturing and clipping to close the fistula. This novel technique was followed by a series of three subsequent endoscopic procedures that enabled us to gradually downsize the fistula over time and ultimately achieve complete closure. The patient's colostomy was eventually reversed with return of bowel continuity. Conclusion: Although uncommon, RVF are significant complications of pelvic surgery. The presence of abdominal/pelvic adhesions from previous surgeries or patient comorbidities can make open surgical repair extremely challenging or impracticable. Therefore, it is important to recognize and consider the use of endoscopic techniques as potential options for closure of rectovesical fistula in certain situations.

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Section: Discussion and Literature Reviewmentioning

confidence: 99%

Section: Discussion and Literature Reviewmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Endoscopic Closure of a Large Rectovesical Fistula Following Robotic Prostatectomy

Watts

Kocher

Pauli

et al. 2020

Journal of Endourology Case Reports

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“…For radiated cases, gracilis muscle interposition may be preferred. Although surgical repair remains the gold standard, there is still no consensus concerning the management of RUF with no data available clearly favoring one approach [2,3]. Therefore, it is mandatory to look for innovative, minimally invasive procedures using biomaterials.…”

Section: Introductionmentioning

confidence: 98%

Management of rectourinary fistula after urological interventions using biodesigned mesh: first experiences of an innovative technique

Gierth

Denzinger

Liebig-Hörl³

et al. 2015

Int J Colorectal Dis

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“…Falavolti and colleagues have reviewed and published their results in employing the York Mason approach to repair of these fistulas [1]. As they so aptly describe, the surgical approach to rectourethral fistula varies and is often related to the etiology of the fistula.…”

mentioning

confidence: 99%

York Mason Procedure to Repair Iatrogenic Rectourinary Fistula

Efron

2013

World j. surg.

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A rectourethral fistula is a devastating complication of prostatectomy that is difficult to treat and may have significant implications for the patient with respect to quality of life after repair. Falavolti and colleagues have reviewed and published their results in employing the York Mason approach to repair of these fistulas [1]. As they so aptly describe, the surgical approach to rectourethral fistula varies and is often related to the etiology of the fistula. Fistulas that are the result of an iatrogenic injury at the time of prostatectomy are small and more easily managed than those caused by severe prostate and rectal necrosis secondary to radiation therapy for prostate cancer. Therefore the method of surgical repair varies.Hechenbleikner et al.[2] in a recent literature review on rectourethral fistula repair, identified four primary approaches to repairing these defects: transanal, transabdominal, trans-sphincteric, and transperineal. Now, we can clearly add the York Mason approach to that list. However, the overall results from the York Mason approach described are not as promising as those seen with more traditional repairs. The authors report only a 50 % success rate, which compares to a 90 % closure rate when using a transperineal approach [2]. The transperineal approach uses an interposition graft of either muscle, usually the gracilis muscle from the leg, or a buchal mucosal flap, which is not described with the York Mason technique. The transperineal or transanal approach also has the added benefit of not dividing the anal sphincter muscles, which may alter longterm fecal continence in patients. The authors of the present study have a large percentage of patients who have undergone more that two repairs before seeking their services,

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York Mason Procedure to Repair Iatrogenic Rectourinary Fistula: Our Experience

Abstract: The posterior trans-sphincteric approach of the York Mason technique is effective in treating RUF.

Cited by 22 publications

References 53 publications

Endoscopic Closure of a Large Rectovesical Fistula Following Robotic Prostatectomy

Endoscopic Closure of a Large Rectovesical Fistula Following Robotic Prostatectomy

Management of rectourinary fistula after urological interventions using biodesigned mesh: first experiences of an innovative technique

York Mason Procedure to Repair Iatrogenic Rectourinary Fistula

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