Lyon Est and Lyon Sud Medical School, Claude Bernard University Lyon 1, Lyon, France; Department of Urology, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France.
Lyon Est and Lyon Sud Medical School, Claude Bernard University Lyon 1, Lyon, France; Department of Urology, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France.
Eur Urol. 2022 Mar;81(3):305-312. doi: 10.1016/j.eururo.2021.09.017. Epub 2021 Oct 20.
Transperineal repair of rectourethral fistula (RUF) following prostate cancer treatment with gracilis muscle flap interposition (GMFI) leads to favourable outcomes, but published data are still lacking, notably concerning functional aspects.
To assess surgical and functional outcomes of this treatment of RUF.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective study was conducted in two referral hospitals including 21 patients who underwent RUF transperineal repair with GMFI between 2008 and 2020.
The standard vertical perineal approach is performed for fistula dissection. Bladder and rectal defects are closed separately. After dissection from its facia, the flap is harvested, preserving its pedicle; it is brought to the perineum and placed between the urethra and the rectum to fully cover the sutures.
Fistula closure (clinical data and postoperative cystography), digestive stoma closure, and complications graded according to the Clavien-Dindo classification were reviewed. Functional results were assessed using the Urinary Symptom Profile (USP) questionnaire, anal incontinence St Mark's score, Patient Observer Scar Assessment Scale (POSAS) score, and a nonvalidated Likert scale questionnaire assessing issues with lower extremity functionality.
The median (interquartile range) follow-up was 27 (8-47) mo. Fistula closure was successful for 20 patients (95% success). Digestive stoma was closed in 10/12 shunted patients (83%). Two (9%) Clavien-Dindo grade ≥3b complications were reported (one urinoma in a kidney transplant patient and one thigh haematoma evacuation). Eighteen patients (86%) completed the postoperative questionnaire; 11/18 (61%) had significant urinary incontinence. The mean (standard deviation) USP dysuria score was 1/9 (1.2), mean St Mark's score was 5/24 (5), mean POSAS score was 19/70 (11), mean lower extremity functionality score was 2/20 (4), and mean procedure patient satisfaction score was 9/10 (2). The retrospective design and limited number of patients are the main limitations.
The present study found an excellent success rate and low morbidity for RUF transperineal repair with GMFI. Functional outcomes were satisfactory despite a high urinary incontinence rate.
We performed an analysis of the outcomes of perineal approach surgery with muscle interposition for closing abnormal communication between the bladder and the rectum after prostate cancer treatment. This surgical technique was found to be safe to perform and provides a high success rate, with patients being satisfied despite poor urinary continence outcomes.
前列腺癌治疗后直肠尿道瘘（RUF）经会阴修复采用腹直肌皮瓣（GMFI）可获得良好的效果，但仍缺乏相关数据，尤其是功能方面的数据。
评估该治疗 RUF 的手术和功能结果。
设计、地点和参与者：本回顾性研究在两家转诊医院进行，纳入了 2008 年至 2020 年间接受经会阴 RUF 修复的 21 例患者，采用 GMFI 治疗。
标准垂直会阴入路用于瘘管解剖。膀胱和直肠缺损分别关闭。皮瓣从筋膜上解剖后，进行游离，保留其蒂；将其带到会阴，置于尿道和直肠之间，以完全覆盖缝线。
回顾瘘口闭合（临床数据和术后膀胱造影）、消化道造口关闭以及根据 Clavien-Dindo 分级的并发症。采用尿症状量表（USP）问卷、肛门失禁 St Mark 评分、患者观察者疤痕评估量表（POSAS）评分和非有效 Likert 量表问卷评估下肢功能问题，评估功能结果。
中位（四分位距）随访时间为 27（8-47）个月。20 例患者（95%成功）瘘口闭合成功。10/12 例分流患者（83%）消化道造口关闭。报告了 2 例（9%）Clavien-Dindo 分级≥3b 的并发症（1 例肾移植患者发生尿囊肿，1 例大腿血肿清除）。18 例患者（86%）完成了术后问卷；11/18（61%）有明显的尿失禁。USP 尿痛评分平均（标准差）为 1/9（1.2），St Mark 评分平均为 5/24（5），POSAS 评分平均为 19/70（11），下肢功能评分平均为 2/20（4），手术患者满意度评分平均为 9/10（2）。回顾性设计和患者数量有限是主要的局限性。
本研究发现，经会阴 GMFI 修复 RUF 的成功率高，发病率低。尽管尿失禁发生率高，但功能结果令人满意。
我们对前列腺癌治疗后经会阴入路肌瓣置入术治疗膀胱与直肠异常沟通的结果进行了分析。该手术技术安全可行，成功率高，患者满意度高，但尿控效果不佳。
