Serra-Aracil Xavier, Labró-Ciurans Meritxell, Mora-López Laura, Muñoz-Rodríguez Jesús, Martos-Calvo Raúl, Prats-López Joan, Navarro-Soto Salvador
General and Digestive Surgery Service, University Hospital Parc Taulí, Sabadell, Barcelona, Spain.
General and Digestive Surgery Service, University Hospital Parc Taulí, Sabadell, Barcelona, Spain.
Urology. 2018 Jan;111:139-144. doi: 10.1016/j.urology.2017.08.049. Epub 2017 Sep 12.
To assess the role of transanal endoscopic operation (TEO) or transanal endoscopic microsurgery (TEM) in rectourethral fistulas (RUF). RUF may appear after radical prostatectomy. Their treatment represents a challenge; many therapies have been proposed, from conservative to aggressive surgical approaches. Transanal endoscopic surgery (TEO or TEM) is a minimally invasive technique to access the site of the RUF to perform repair.
This is an observational study with prospective data collection, conducted between September 2006 and December 2015. All patients were diagnosed with RUF following management of prostate cancer. Conservative treatment was administered in the form of urinary and fecal diversion with cystotomy and terminal colostomy, to achieve total urinary and fecal exclusion. If the fistula persisted, it was treated by TEO or TEM, with or without biological mesh interposition. If this failed, gracilis muscle was applied as salvage therapy.
Ten patients were diagnosed with RUF. In 1 patient (1 of 10), the fistula healed with bladder catheterization alone. In another patient (1 of 9), it resolved after total urinary and fecal exclusion. Eight patients underwent repair by TEO or TEM, 4 with biological mesh interposition; all 4 presented recurrence. In the other 4 patients treated via TEO or TEM, 2 had early recurrence, whereas the others had healed at follow-up visits after 4-6 months (2 of 8)-a success rate of 25%. The 6 patients who recurred were treated with gracilis muscle interposition via a transperineal approach.
The low rate of positive results obtained by TEO or TEM argues against its use as technique of choice in RUF, and against the use of biological meshes.
评估经肛门内镜手术（TEO）或经肛门内镜显微手术（TEM）在直肠尿道瘘（RUF）治疗中的作用。RUF可能出现在前列腺癌根治术后。其治疗颇具挑战性；从保守治疗到积极的手术方法，人们提出了多种治疗方案。经肛门内镜手术（TEO或TEM）是一种微创手术技术，可进入RUF部位进行修复。
这是一项前瞻性数据收集的观察性研究，于2006年9月至2015年12月进行。所有患者在前列腺癌治疗后被诊断为RUF。采用膀胱切开术和末端结肠造口术进行尿流改道和粪流改道的保守治疗，以实现完全尿粪分流。如果瘘管持续存在，则采用TEO或TEM治疗，可使用或不使用生物补片。如果治疗失败，则采用股薄肌作为挽救治疗。
10例患者被诊断为RUF。1例患者（10例中的1例）仅通过膀胱插管瘘管愈合。另1例患者（9例中的1例）在完全尿粪分流后瘘管消失。8例患者接受了TEO或TEM修复，4例使用了生物补片；所有4例均复发。在其他4例接受TEO或TEM治疗的患者中，2例早期复发，而其他患者在4 - 6个月后的随访中愈合（8例中的2例），成功率为25%。6例复发患者通过经会阴途径采用股薄肌植入治疗。
TEO或TEM获得的阳性结果率较低，这表明不支持将其作为RUF的首选技术，也不支持使用生物补片。
