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经直肠前列腺根治术后联合带蒂腹直肌皮瓣转移修补尿道直肠瘘

Transsphincteric Repair of Rectourethral Fistulas in Combination With Dartos Muscle Flap Interposition Following Radical Prostatectomy.

机构信息

Colorectal Unit, Department of Surgery and Urology, Eskilstuna County Hospital, Eskilstuna, Sweden.

出版信息

Urology. 2024 Sep;191:130-135. doi: 10.1016/j.urology.2024.05.041. Epub 2024 Jun 2.

Abstract

OBJECTIVE

To present our experience with a novel technique that combines the York-Mason transsphincteric approach with dartos muscle flap interposition to treat rectourethral fistulas.

METHODS

We extracted records from our prospectively kept database of 35 procedures conducted for treating rectourethral fistulas during 2002-2023; the York-Mason approach was combined with dartos muscle flap interposition in 5 cases, performed for treating rectourethral fistulas due to radical prostatectomy, all of which were referral cases.

RESULTS

All 5 patients were successfully treated and followed up for a median of 70.0 months without recurrence. Before the fistula repair, all had a diverting stoma. In all cases, the first voiding cystourethrogram revealed a healed fistula. The posterior and the scrotal incisions healed uneventfully. All patients reported normal voiding and no urinary incontinence. To date, the stoma has closed in 3 patients, all of whom had intact fecal continence and no postoperative anal stenosis.

CONCLUSION

The transsphincteric modified York-Mason approach combined with dartos muscle flap interposition resulted in complete healing of rectourethral fistulas.

摘要

目的

介绍一种将约克-梅森经括约肌入路与腹外斜肌腱膜瓣转移相结合治疗直肠尿道瘘的新方法。

方法

我们从 2002 年至 2023 年期间为治疗直肠尿道瘘而进行的 35 例前瞻性保存数据库中提取记录;在 5 例因根治性前列腺切除术导致直肠尿道瘘的患者中,采用了约克-梅森入路联合腹外斜肌腱膜瓣转移,均为转诊病例。

结果

所有 5 例患者均成功治疗并随访中位数为 70.0 个月,无复发。在瘘管修复前,所有患者均有转流造口。在所有病例中,首次排尿性膀胱尿道造影显示瘘管已愈合。会阴和阴囊切口均愈合良好。所有患者均报告排尿正常,无尿失禁。迄今为止,3 例患者的造口已关闭,所有患者均具有完整的粪便控制功能,且无术后肛门狭窄。

结论

经括约肌改良约克-梅森入路联合腹外斜肌腱膜瓣转移可使直肠尿道瘘完全愈合。

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