Département de Chirurgie Urologique, Institut Mutualiste Montsouris, Université Paris Descartes, 42, Boulevard Jourdan, 75014, Paris, France.
World J Urol. 2018 Jun;36(6):947-954. doi: 10.1007/s00345-018-2212-z. Epub 2018 Feb 13.
Iatrogenic recto-urinary fistulas are a disastrous complication of therapeutic interventions on the prostate. Many surgical approaches have been described to repair recto-urinary fistulas and no consensus has been reached regarding the better approach. The objective of this study is to present the results of our updated 20-year experience in the surgical management of recto-urinary fistula using a modified York Mason procedure.
We proceed to a retrospective single-institution review of surgically treated patients for iatrogenic recto-urinary fistulas between 1998 and 2017 by the modified York Mason technique. Descriptive analysis of our population was performed. Continuous and categorical variables were compared using Mann-Whitney and Fischer tests, respectively. All tests were two-sided with a significance level set at p value < 0.05.
We included 30 consecutive patients treated for iatrogenic recto-urinary fistula. The median follow-up was 76 months (2-195). The median size of the fistula was 5 mm (2-20). Successful healing of the recto-urinary fistula was observed in 80, 97, and 100% of patients after 1, 2, or 3 York Mason procedure. During the study period, no one single case of acquired urinary incontinence or durable fecal incontinence has been observed.
Our modified York Mason technique is a reliable and effective procedure with a 100% success rate for the repair of small iatrogenic recto-urinary fistulas in non-irradiated patients. It has a very low morbidity rate, and no case of postoperative urine or fecal incontinence has been observed.
医源性直肠-尿道瘘是前列腺治疗性干预的灾难性并发症。已经描述了许多手术方法来修复直肠-尿道瘘，但对于哪种方法更好尚未达成共识。本研究的目的是介绍我们使用改良 York Mason 手术修复直肠-尿道瘘的 20 年更新经验的结果。
我们对 1998 年至 2017 年间通过改良 York Mason 技术治疗的医源性直肠-尿道瘘患者进行了回顾性单中心回顾。对我们的人群进行了描述性分析。使用 Mann-Whitney 和 Fischer 检验分别比较连续和分类变量。所有检验均为双侧检验，显著性水平设为 p 值 < 0.05。
我们纳入了 30 例连续接受改良 York Mason 手术治疗的医源性直肠-尿道瘘患者。中位随访时间为 76 个月（2-195）。瘘口的中位大小为 5mm（2-20）。在第 1、2 和 3 次 York Mason 手术后，分别有 80%、97%和 100%的患者成功治愈直肠-尿道瘘。在研究期间，没有观察到一例获得性尿失禁或永久性粪便失禁。
我们的改良 York Mason 技术是一种可靠有效的方法，对于非放疗患者的小医源性直肠-尿道瘘，成功率为 100%。它的发病率非常低，没有观察到术后尿失禁或粪失禁的病例。
