Muñoz-Duyos Arantxa, Navarro-Luna Albert, Pardo-Aranda Fernando, Caballero Josep M, Borrat Pere, Maristany Carles, Pando José A, Veloso Enrique
1 Unit of Colorectal Surgery, Department of General Surgery, Hospital Universitari MútuaTerrassa, Universitat de Barcelona, Barcelona, Spain 2 Department of Urology, Hospital Universitari MútuaTerrassa, Universitat de Barcelona, Barcelona, Spain.
Dis Colon Rectum. 2017 Apr;60(4):393-398. doi: 10.1097/DCR.0000000000000763.
Postoperative rectourethral fistula after radical prostatectomy is an infrequent but very serious problem.
We aimed to describe our experience with transperineal repair and unilateral gracilis muscle interposition in patients with rectourethral fistula after radical prostatectomy in nonradiated prostate cancer.
This was a cohort study.
All of the procedures were performed at the same hospital by the same multidisciplinary team made up of a senior colorectal surgeon and a senior urologist.
Patients with postoperative rectourethral fistula after laparoscopic prostatectomy were included.
Transperineal fistula repair and gracilis muscle interposition were included.
Fistula healing rate was measured.
Nine patients with postoperative rectourethral fistula were treated between November 2009 and February 2016. Four of them had received other previous treatments without success, and 5 had previously been treated with this technique. Seven patients had a fecal diverting stoma. After a median follow-up of 54 months (range, 2-72), all of the fistulas had successfully healed, and, to date, the patients remain asymptomatic without urinary diversion. Fecal diversion was closed in all but 1 patient. No intraoperative or infectious complications were detected. With the results of our series, we present specific technical details of our technique and hope to provide additional evidence of the low morbidity profile and excellent healing rate of this treatment. Moreover, we note that, although small, this series corresponds with a homogeneous group of patients with rectourethral fistula after radical prostatectomy in nonradiated prostate cancer.
This is a small but very homogeneous group of patients.
Simple repair with perineal gracilis muscle interposition is a safe and effective technique for the treatment of postoperative rectourethral fistulas after nonradiated prostate cancer surgery.
根治性前列腺切除术后发生直肠尿道瘘是一个少见但非常严重的问题。
我们旨在描述在非放疗前列腺癌根治性前列腺切除术后直肠尿道瘘患者中行经会阴修补及单侧股薄肌植入术的经验。
这是一项队列研究。
所有手术均由同一多学科团队在同一家医院完成，该团队由一名资深结直肠外科医生和一名资深泌尿外科医生组成。
纳入腹腔镜前列腺切除术后发生直肠尿道瘘的患者。
包括经会阴瘘修补及股薄肌植入术。
测量瘘口愈合率。
2009年11月至2016年2月期间，9例术后直肠尿道瘘患者接受了治疗。其中4例曾接受其他治疗但未成功，5例曾接受过该技术治疗。7例患者有粪便转流造口。中位随访54个月（范围2 - 72个月）后，所有瘘口均成功愈合，迄今为止，患者无尿流改道且无症状。除1例患者外，所有患者的粪便转流造口均已关闭。未发现术中或感染并发症。根据我们系列研究的结果，我们介绍了该技术的具体技术细节，希望为这种治疗方法的低发病率和高愈合率提供更多证据。此外，我们注意到，尽管该系列病例数较少，但患者均为非放疗前列腺癌根治性前列腺切除术后发生直肠尿道瘘的同质群体。
这是一个病例数少但非常同质的患者群体。
经会阴股薄肌植入简单修补术是治疗非放疗前列腺癌手术后直肠尿道瘘的一种安全有效的技术。
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