V4-12: Robotic Repair for Rectourethral Fistula: A new technique
VideoIntroductions and Objectives
Rectourethral fistulas (RUFs) are rare but challenging entities.. They most frequently appear as an iatrogenic complication of extirpative or ablative prostate procedures. After a failed initial attempt at spontaneous closure of fistulas with conservative measures, many surgical techniques and approaches have been proposed for the treatment of RUF, including minimally invasive approaches. Herein we describe a novel robotic technique of RUF repair.
An 80 year-old man with a post-radiation rectourethral fistula in the prostatic urethra next to the verumotanum. This developed after chemoradiation protocol and surgical removal of a rectal adenocarcinoma with end-to-end bowel restoration in continuity. The technique included intrafascial robotic simple prostatectomy with seminal vesicle preservation, two layer rectal closure, bladder mobilization, and urethrovesical anastomosis in a standard running fashion over a urethral catheter. A suprapubic catheter and surgical drain were left in place
The mean operative time was 180 min, mean estimated blood loss 250ml, the hospital stay was 3 days, and no intraoperative complications occurred. The drain was removed on the 5th day. After one month of follow up, a cystogram was performed and evidence of filiform tract with contrast towards the rectum was seen and the catheter was left in place.. After 2 months, a small blind ending tract remained, the suprapubic catheter was removed and urethral catheter was left in for 1 additional month. At that point the small tract was assumed to be epithelialized and not a fistula. The catheter was removed. Restoring bowel continuity is planned.
Robotic repair of intraprostatic RUF with robotic prostatectomy and urethrovesical reanastomosis is feasible and represents an attractive alternative to the standard approaches, even in a complex post-radiation setting. This technique requires advanced robotic experience.