Moretto G, Casaril A, Inama M
General Surgery Unit, Hospital "Dott. Pederzoli", Via Monte Baldo 24, 37019, Peschiera del Garda, Verona, Italy.
Bioengineering and Medical-Surgical Sciences, Politecnico di Torino, Turin, Italy.
Int Urol Nephrol. 2017 Sep;49(9):1605-1609. doi: 10.1007/s11255-017-1652-5. Epub 2017 Jul 10.
To report the author's experience on a mini-invasive technique using bioprosthetic plug and a rectal wall flap advancement in the treatment of recurrent recto-urethral fistula.
Between 2013 and 2015, seven patients with recurrent recto-urethral fistula were referred to the Pederzoli Hospital, Peschiera del Garda, Verona, Italy. Intraoperatively all patients were found to have a rectal wall lesion and were treated with urinary and fecal diversion. For the persistence of the fistula, all the patients underwent a mini-invasive treatment consisting on placement of a bioprosthetic plug in the fistula covered by an endorectal advancement flap through a trans-anal and trans-urethral combined technique.
Median operative time was 48 min with a median blood loss of 30 ml. Median hospital stay was 3 days (IQR 1-3). No case of fistula recurrence or plug migration was described. None of the patients experienced fecal or urinary incontinence. All patients obtained complete fistula healing.
Recurrent recto-urethral fistula is a challenging postsurgical complication for surgeons and urologists, and its best treatment is still unknown. Our method seems to be feasible and effective for the treatment of complex recto-urethral fistula.
报告作者使用生物假体塞和直肠壁瓣推进的微创技术治疗复发性直肠尿道瘘的经验。
2013年至2015年期间，7例复发性直肠尿道瘘患者被转诊至意大利维罗纳加尔达湖畔佩斯基耶拉的佩德佐利医院。术中发现所有患者均有直肠壁病变，并接受了尿流改道和粪流改道治疗。由于瘘管持续存在，所有患者均接受了微创治疗，即通过经肛门和经尿道联合技术，在瘘管内放置生物假体塞，并覆盖直肠推进瓣。
中位手术时间为48分钟，中位失血量为30毫升。中位住院时间为3天（四分位间距1 - 3天）。未描述有瘘管复发或塞子移位的病例。所有患者均未出现大便失禁或尿失禁。所有患者的瘘管均完全愈合。
复发性直肠尿道瘘对外科医生和泌尿外科医生来说是一种具有挑战性的术后并发症，其最佳治疗方法仍不明确。我们的方法似乎对治疗复杂的直肠尿道瘘是可行且有效的。
