Popov S V, Orlov I N, Gadjiev N K, Obidnyak V M, Sytnik D A, Kulikov A Y, Akopyan G N, Gadzhieva Z K, Spiridonov N Y
St. Petersburg Clinical Hosital named after St Luka, Sankt Peterburg, Saint-Petersburg, Russia.
Department of Urology Saint Petersburg Pavlov State Medical University, Saint-Petersburg, Russia.
Urologiia. 2019 Dec 31(6):44-47.
& Objectives. Rectal injury and recto-urethral fistula (RUF) formation are severe complications after surgical treatment of prostate cancer . There are various surgical techniques as well as conservative methods for the treatment of RUF. Nonsurgical approach can be used in nontoxic, minimally symptomatic patients.
MATERIALS & METHODS: From 2012 to 2016, 825 patients (mean age 68y) with LPR to be performed were recruited in the study. Postoperatively RUF developed in 7 patients (0.8%) in average in 10 days after surgery. Five cases were uncomplicated presented with pneumaturia, dysuria or urine per rectum. Two patients with fecaluria and previous history of radiotherapy or androgen deprivation were excluded from the study group. Conservative management include: 1)bowel rest 2)broad-spectrum antibiotics after urine culture 3) fully absorbable diet (combination of parenteral and enteral nutrition) 4) bladder drainage (urethral catheter or suprapubic tube). Duration of conservative treatment was 4 weeks. After treatment all patients underwent a voiding cystourethrogram.
During the treatment one patient has developed severe UTIs and surgical treatment were perfomed. The remaining 4 patients had spontaneous healing of the fistula and normal cystourethrogram. With the median follow up of 24 month after RUF treatment all 4patients had no fistula signs and they were fully continent. Overall RUF closure using nonsurgical treatment was successful in 4 of 5 cases (80%).
Conservative management of RUF is a highly effective option which can be used to avoid major surgery and temporary colostomy. Nonsurgical treatment is a feasible method in selected patients with RUF.
及目的。直肠损伤和直肠尿道瘘（RUF）形成是前列腺癌手术治疗后的严重并发症。治疗RUF有多种手术技术以及保守方法。对于无毒、症状轻微的患者可采用非手术方法。
2012年至2016年，本研究招募了825例拟行低位直肠前切除术（LPR）的患者（平均年龄68岁）。术后平均10天，7例患者（0.8%）发生RUF。5例病情不复杂，表现为气尿、排尿困难或经直肠排尿。2例有粪尿症且有放疗或雄激素剥夺史的患者被排除在研究组之外。保守治疗包括：1）肠道休息；2）尿培养后使用广谱抗生素；3）完全可吸收饮食（肠外营养与肠内营养相结合）；4）膀胱引流（尿道导管或耻骨上管）。保守治疗持续时间为4周。治疗后所有患者均接受了排尿性膀胱尿道造影。
治疗期间1例患者发生严重尿路感染并接受了手术治疗。其余4例患者瘘口自发愈合，膀胱尿道造影正常。RUF治疗后中位随访24个月，所有4例患者均无瘘口迹象，且完全控尿。5例患者中4例（80%）采用非手术治疗成功闭合RUF。
RUF的保守治疗是一种高效的选择，可避免大手术和临时结肠造口术。非手术治疗是RUF特定患者的一种可行方法。
