Clinical Department, Faculty of Medical Sciences, Universidad Europea de Madrid, Madrid, Spain.
Hospital Universitario de Getafe, Madrid, Spain.
Int Braz J Urol. 2021 Mar-Apr;47(2):399-412. doi: 10.1590/S1677-5538.IBJU.2020.0476.
To evaluate efficacy of urorectal fistula (URF) repair using different approaches and the clinical factor determinant of success, and also the morbidity associated to the procedure and health-related quality of life (HRQoL) in male survivors of pelvic malignancies.
Retrospective evaluation of 39 patients with URF primarily intervened in three institutions using different surgical approaches. Success was defined as effective fistula closure. Variables evaluated included demographics, previous treatments, surgical approach, ancillary surgeries, complications and HRQoL by using a standardized non-validated specific questionnaire. Median follow-up from surgery to interview was 55 months (interquartile range 49, range 4-112). Factors determinant of success were investigated using logistic regression. Safety of the procedure was evaluated by Clavien-Dindo scale. Deterioration of continence and erectile function and other HRQoL issues were evaluated.
Prostate cancer treatment was the predominant etiology. The success rate for fistula repair was 89.5%. The surgical approach was not related to failed repair (p=0.35) or complications (p=0.29). Factors associated with failure were complications (p=0.025), radiotherapy (p=0.03), fistula location (p=0.04) and fistula size (p=0.007). Multivariate analysis revealed fistula size was the only independent determinant of failure (OR 6.904, 1.01-47.75). Complications occurred in 46.2% and severe complications in 12.8%. The mortality related to the procedure was 2.6%. Urinary incontinence was present before repair in 26.3% and erectile dysfunction in 89.5%. Fistula repair caused de novo urinary incontinence in 7.9% and deterioration of erectile status in 44.7%. Globally 79% were satisfied after repair and only 7.9% rated HRQoL as unhappy. Trans-sphincteric approach was related to less deterioration of erectile function (p=0.003), and higher perceived satisfaction in QoL (p=0.04).
The surgical approach elected to correct URF is not determinant of success nor of complications. Fistula size appears as independent determinant for failure. Trans-sphincteric approach could be advantageous over other procedures regarding HRQoL issues.
评估使用不同方法修复尿直肠瘘（URF）的疗效，以及影响手术成功率的临床因素，还评估了男性盆腔恶性肿瘤幸存者接受该手术的发病率和健康相关生活质量（HRQoL）。
回顾性分析了 39 例在三个机构中使用不同手术方法进行初次干预的 URF 患者。成功定义为瘘管有效闭合。评估的变量包括人口统计学、先前的治疗、手术方法、辅助手术、并发症和使用标准化非有效特定问卷评估的 HRQoL。从手术到访谈的中位随访时间为 55 个月（四分位距 49，范围 4-112）。使用逻辑回归分析了成功的决定因素。使用 Clavien-Dindo 量表评估了手术的安全性。评估了控尿和勃起功能恶化以及其他 HRQoL 问题。
前列腺癌治疗是最常见的病因。瘘管修复成功率为 89.5%。手术方法与修复失败（p=0.35）或并发症（p=0.29）无关。与失败相关的因素是并发症（p=0.025）、放疗（p=0.03）、瘘管位置（p=0.04）和瘘管大小（p=0.007）。多变量分析显示，瘘管大小是唯一独立的失败决定因素（OR 6.904，1.01-47.75）。46.2%的患者发生并发症，12.8%的患者发生严重并发症。与该手术相关的死亡率为 2.6%。26.3%的患者在修复前存在尿失禁，89.5%的患者存在勃起功能障碍。瘘管修复导致 7.9%的患者新发尿失禁，44.7%的患者勃起功能恶化。修复后 79%的患者满意，只有 7.9%的患者对生活质量不满意。经括约肌入路与勃起功能恶化程度较轻（p=0.003）和 QoL 满意度较高（p=0.04）相关。
选择修复 URF 的手术方法既不是手术成功率的决定因素，也不是并发症的决定因素。瘘管大小是影响手术失败的独立决定因素。经括约肌入路在 HRQoL 问题方面可能优于其他方法。
