Martins Francisco E, Felicio João, Oliveira Tiago Ribeiro, Martins Natália, Oliveira Vítor, Palmas Artur
Department of Urology, School of Medicine, University of Lisbon, Hospital Santa Maria (CHLN), 1649-028 Lisbon, Portugal.
Hospital das Forças Armadas, 1649-020 Lisbon, Portugal.
J Clin Med. 2021 Sep 5;10(17):4014. doi: 10.3390/jcm10174014.
To report a series of men with a rectourethral fistula (RUF) resulting from pelvic cancer treatments and explore their therapeutic differences and impact on the functional outcomes and quality of life highlighting the adverse features that should determine permanent urinary or dual diversion.
A retrospective database search was performed in four centers to identify patients with RUF resulting from pelvic cancer treatment. Medical records were analyzed for the demographics, comorbidities, diagnostic evaluation, fistula characteristics, surgical approaches and outcomes. The endpoints analyzed included a successful fistula closure following a repair and the impact of the potential adverse features on outcomes.
Twenty-three patients, aged 57-79 years (median 68), underwent an RUF reconstruction. The median follow-up (FU) was 54 months (range 18-115). The patients were divided into two groups according to the etiology: radiation/energy-ablation treatments with or without surgery (G1, = 10) and surgery only (G2, = 13). All of the patients underwent a temporary diverting colostomy and suprapubic cystostomy. Overall, a successful RUF closure was achieved in 18 (78%) patients. An interposition flap was used in six (60%) patients and one (7.7%) patient in groups G1 and G2, respectively ( = 0.019). The RUF was managed successfully in all 13 patients in group G2 as opposed to 5/10 (50%) in group G1 ( = 0.008). The patients in the radiation/energy-ablation group were more likely to require permanent dual diversion (50% vs. 0%, < 0.0075).
Radiation/energy-ablation therapies are associated with a more severe RUF and more complex reconstructions. Most of these patients require an abdominoperineal approach and flap interposition. The failure of an RUF repair with the need for permanent dual diversion, eventually combined with extirpative surgery, is higher after previous radiation/energy-ablation treatment. Therefore, permanent dual diversion as the primary treatment should always be included in the decision-making process as reconstruction may be futile in specific settings.
报告一系列因盆腔癌治疗导致直肠尿道瘘（RUF）的男性病例，并探讨其治疗差异以及对功能结局和生活质量的影响，强调应决定永久性尿流改道或双重尿流改道的不良特征。
在四个中心进行回顾性数据库检索，以识别因盆腔癌治疗导致RUF的患者。分析病历中的人口统计学、合并症、诊断评估、瘘管特征、手术方法和结局。分析的终点包括修复后瘘管成功闭合以及潜在不良特征对结局的影响。
23例年龄在57 - 79岁（中位年龄68岁）的患者接受了RUF重建。中位随访时间为54个月（范围18 - 115个月）。根据病因将患者分为两组：接受或未接受手术的放射/能量消融治疗（G1组，n = 10）和仅接受手术治疗（G2组，n = 13）。所有患者均接受了暂时性转流性结肠造口术和耻骨上膀胱造瘘术。总体而言，18例（78%）患者实现了RUF的成功闭合。G1组和G2组分别有6例（60%）和1例（7.7%）患者使用了插入皮瓣（P = 0.019）。G2组的13例患者中RUF均成功处理，而G1组为5/10（50%）（P = 0.008）。放射/能量消融组的患者更有可能需要永久性双重尿流改道（50%对0%，P < 0.0075）。
放射/能量消融疗法与更严重的RUF和更复杂的重建相关。这些患者中的大多数需要经腹会阴途径和皮瓣插入。先前接受放射/能量消融治疗后，RUF修复失败且需要永久性双重尿流改道（最终可能联合根治性手术）的情况更为常见。因此，在决策过程中应始终将永久性双重尿流改道作为主要治疗方法，因为在特定情况下重建可能无效。
