Sotelo Rene, Garcia Alejandro, Yaime Henry, Rodríguez Eduardo, Dubois Rinci, Andrade Robert De, Carmona Oswaldo, Finelli Antonio
Section of Laparoscopic and Minimally Invasive Surgery, Department of Urology, "La Floresta" Medical Institute, Caracas, Venezuela.
J Endourol. 2005 Jul-Aug;19(6):603-7. doi: 10.1089/end.2005.19.603.
Rectovesical fistula (RVF) is a rare complication of radical prostatectomy. A 62- year-old man with clinically localized prostate cancer underwent open radical prostatectomy that was complicated by rectal injury and subsequent RVF development. Conservative management failed, and the patient was referred for surgical correction.
The operative steps consisted of (1) cystoscopy, (2) RVF catheterization, (3) ureteral catheterization, (4) five-port transperitoneal laparoscopic approach, (5) cystotomy, (6) opening of the fistulous tract, (7) dissection between the bladder and the rectum, (8) closure of the rectum, (9) interposition of omentum, (10) suprapubic cystostomy placement, (11) bladder closure, and (12) colostomy creation.
The operative time was 240 minutes. The hospital stay was 3 days. The urethral catheter was kept indwelling for 4 days. At 8 weeks postoperatively, the suprapubic tube was removed and the colostomy reversed. At 1-month follow-up, the patient remains free of fistula recurrence.
Laparoscopic rectovesical fistula repair is feasible and represents an attractive alternative to the standard approaches.
直肠膀胱瘘（RVF）是根治性前列腺切除术的一种罕见并发症。一名62岁临床局限性前列腺癌男性患者接受了开放性根治性前列腺切除术，术后出现直肠损伤及随后的RVF。保守治疗失败后，患者转诊接受手术矫正。
手术步骤包括：（1）膀胱镜检查；（2）RVF置管；（3）输尿管置管；（4）五孔经腹腹腔镜入路；（5）膀胱切开术；（6）瘘管切开；（7）膀胱与直肠间分离；（8）直肠闭合；（9）大网膜置入；（10）耻骨上膀胱造瘘管置入；（11）膀胱闭合；（12）结肠造口术。
手术时间为240分钟。住院时间为3天。尿道导管留置4天。术后8周，耻骨上管拔除，结肠造口还纳。术后1个月随访，患者无瘘管复发。
腹腔镜直肠膀胱瘘修补术可行，是标准治疗方法的一种有吸引力的替代方案。
