Singla Nirmish, Morey Allen F
Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Curr Opin Urol. 2016 Mar;26(2):171-6. doi: 10.1097/MOU.0000000000000263.
This article discusses etiologic considerations, evaluation, and contemporary approaches to managing rectourethral fistula (RUF) with particular emphasis on geriatric patients.
With the advent of multimodal approaches to treating prostate cancer, such as radiation and ablative therapies, the incidence of RUF is increasing, especially in the geriatric population. Surgical repair and healing of RUF in patients with prior radiation is more challenging than in those without prior radiation or ablation because of fibrotic and ischemic changes in surrounding tissues. There is, at present, a lack of consensus over a standardized approach to RUF management because of the heterogeneity in presentation and limited, primarily retrospective, experience in the literature. Nonetheless, an evolving array of surgical approaches now exists for fistula excision and tissue interposition.
Immediate recognition and management of RUF is paramount to prevent related complications. Patient selection and counseling are key to selecting the best approach for repair, whereas a multidisciplinary team, including colorectal and plastic surgery colleagues, may optimize outcomes.
本文讨论了直肠尿道瘘（RUF）的病因、评估及现代治疗方法，尤其着重于老年患者。
随着多模式前列腺癌治疗方法的出现，如放疗和消融治疗，RUF的发病率正在上升，特别是在老年人群中。由于先前接受放疗患者周围组织存在纤维化和缺血性改变，RUF的手术修复及愈合比未接受过放疗或消融的患者更具挑战性。目前，由于临床表现的异质性以及文献中主要为回顾性研究且经验有限，对于RUF的标准化治疗方法尚无共识。尽管如此，目前已有一系列不断发展的手术方法用于瘘管切除和组织植入。
RUF的及时识别和处理对于预防相关并发症至关重要。患者选择和咨询是选择最佳修复方法的关键，而包括结直肠外科和整形外科医生在内的多学科团队可能会优化治疗效果。
