Department of Surgical and Biomedical Sciences, Urology Clinic, University of Perugia, Santa Maria della Misericordia Hospital Piazzale Menghini, Perugia, Italy.
Int Braz J Urol. 2020 May-Jun;46(3):481-482. doi: 10.1590/S1677-5538.IBJU.2018.0584.
: Prostatourethrorectal fistula (PURF) is an uncommon complication resulting from surgery, radiation or trauma (1). The most common therapeutic management is transperineal surgery (1). Transabdominal approach is less used and limited to large fistulae needing cystectomy and rectal resection (1). The aim of this study was to show an original robotic technique of conservative treatment for PURF.
: A 75 years old man referred recurrent UTI, pneumaturia and urinary loss from rectum due to PURF arising after TURP performed after transvesical prostate adenomectomy. Cystogram, cystoscopy and MRI confirmed PURF. We used a robotic approach performing isolation, resection and suture of the fistulous tract on rectal and urethral side. Leak test was negative. We carried out an omental flap, positioned between rectum and prostatic urethra, and a temporary ileostomy without any bowel resection or urinary diversion.
: Operative time was 210 minutes, estimated blood loss 50ml. Oral feeding was restored at 48 hours. Bladder catheter was removed on the 15th post-operative day. Post-operative cystogram was negative. Post-operative complications were ileus and urinary tract infection. Hospital stay was 10 days. At 6 months follow-up, before temporary ileostomy closure, cystoscopy showed a totally re-epithelised fovea, and cystogram and CT enterography were negative.
: Robotic conservative treatment of PURF seems to be safe and feasible (2, 3). Robotic approach allows accurate surgical dissection, through easier access to the rectal-prostatic plane, reducing the need for resection. To our knowledge, this is the first robotic conservative treatment for PURF reproducing the same steps of laparotomic approach with the advantages of minimally invasive technique (4).
前列腺尿道直肠瘘（PURF）是一种由手术、放疗或外伤引起的罕见并发症（1）。最常见的治疗方法是经会阴手术（1）。经腹入路应用较少，仅限于需要行膀胱切除术和直肠切除术的大瘘（1）。本研究旨在介绍一种经机器人治疗 PURF 的创新保守治疗方法。
一名 75 岁男性因 TURP 后经膀胱前列腺切除术引起的 PURF 出现反复尿路感染、气尿和直肠漏尿而就诊。膀胱造影、膀胱镜和 MRI 证实为 PURF。我们采用机器人方法，对直肠和尿道侧的瘘管进行隔离、切除和缝合。漏尿试验为阴性。我们采用网膜瓣，置于直肠和前列腺尿道之间，并进行暂时性回肠造口术，而无需进行任何肠切除术或尿流改道。
手术时间为 210 分钟，失血量估计为 50ml。术后 48 小时恢复口服饮食。术后 15 天拔除膀胱导管。术后膀胱造影阴性。术后并发症为肠梗阻和尿路感染。住院时间为 10 天。在暂时性回肠造口关闭前的 6 个月随访中，膀胱镜检查显示窝完全再上皮化，膀胱造影和 CT 肠造影均为阴性。
机器人治疗 PURF 似乎是安全可行的（2、3）。机器人方法可通过更容易进入直肠-前列腺平面进行准确的手术解剖，减少切除的需要。据我们所知，这是首例应用机器人技术对 PURF 进行的保守治疗，复制了剖腹手术的相同步骤，具有微创技术的优势（4）。
