V05-05: MINIMALLY INVASIVE MANAGEMENT OF RECTOURETHRAL FISTULAS
Many approaches have been described for the surgical management of Rectourethral fistulas (RUF). Herein, we outline our experience with minimally invasive surgery (MIS) for the repair of RUF based 10 continuous patients and describe our step-by-step approach.
After IRB approval was obtained (HS-17-00208), patients who underwent laparoscopic/robotic repair of RUF were identified. All cases were performed by an experienced surgeon (RS) between 2004 and 2018. Follow-up schedule was at 1, 3, 6 and 12 months, respectively. Baseline characteristics included age, sex and etiology. Operative characteristics evaluated included operating time (OT), estimated blood loss (EBL), intraoperative complications, length of hospital stay (LOS), transfusion rate, 90-day complications, and success rate. Continuous variables were summarized as mean and standard deviation (SD) while categorical variables were shown in frequencies and percentages.
Ten male patients were identified. 4 cases (40%) developed after surgical procedures: lower colon resection, transurethral resection of prostate, simple prostatectomy, and perianal fistula repair. One patient also received previous external beam radiotherapy (EBRT). 6 cases occurred after cryotherapy (three, one with concomitant brachytherapy), high intensity focused ultrasound (two, one with concomitant EBRT), and EBRT with concomitant brachytherapy (one). Laparoscopic and robotic repair was performed in 4, and 6 cases, respectively. The procedure consisted of a salvage prostatectomy, closure of the rectal defect, tissue interposition, and vesicourethral anastomosis. Mean (SD) OT was 235.9 (72.1) minutes, mean EBL was 166 (92.2), no transfusions, conversions or intraoperative complications were recorded. Three fecal diversions were performed concomitantly with the surgical repair. 1 major postoperative complication was reported. LOS was 4.8 (4.02). 6 out of 8 patients reported complete continence at 12 months of follow up (2 patients lost during follow-up). No artificial urinary sphincter placement was needed. 9/10 fecal diversions were reversed. At 12 months of follow-up, no recurrences were found.
Our preliminary results showed MIS to be a feasible and successful technique for RUF repair. More studies are needed.