Daniel A Kaufman1, Leonard N Zinman1, Jill C Buckley2, Peter Marcello3, Brendan M Browne1, Alex J Vanni4. 1. Institute of Urology, Lahey Hospital and Medical Center, Burlington, MA. 2. Department of Urology, University of California San Diego Medical Center, San Diego, CA. 3. Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, MA. 4. Institute of Urology, Lahey Hospital and Medical Center, Burlington, MA. Electronic address: alex.vanni@lahey.org.
Abstract
OBJECTIVE: To analyze and report 30-day, 90-day, and long-term complications and surgical outcomes over a 17-year period for anterior transperineal repair of rectourethral fistulas (RUFs) resulting from pelvic radiation and surgery. MATERIALS AND METHODS: We performed a retrospective review of patients undergoing RUF repair between January 1, 1998 and February 28, 2015, at a single institution. All RUF were repaired using an anterior transperineal approach with an interposition muscle flap and selective use of a buccal mucosa graft onlay. RESULTS: Ninety-eight patients underwent repair with an anterior transperineal approach and muscle interposition flap (49 non-radiation induced and 49 radiation or ablation induced). Thirty- and 90-day complication rates were 29% and 2%, respectively, for non-radiated RUF, and 29% and 24%, respectively, for radiated RUF. Urethral diverticula, urinary incontinence, urethral stricture, and bowel problems were delayed complications requiring surgery. At a median follow-up of 14.5 months (range 3-144), 98% (48 of 49) of non-radiated RUF were closed with 1 procedure, whereas 86% (42 of 49) of radiated RUF were closed with 1 procedure. Gastrointestinal tract continuity was restored in 94% (45 of 48) of non-radiated RUF and in 65% (30 of 46) of radiated RUF. CONCLUSION: Successful RUF closure is possible in 98% of non-radiated and in 86% of radiated or ablated patients with 1 procedure. Most radiation-induced RUF, regardless of size, can be successfully repaired with minimal short-term complications. Delayed complications may arise and require surgery, and thus continued surveillance is recommended.
OBJECTIVE: To analyze and report 30-day, 90-day, and long-term complications and surgical outcomes over a 17-year period for anterior transperineal repair of rectourethral fistulas (RUFs) resulting from pelvic radiation and surgery. MATERIALS AND METHODS: We performed a retrospective review of patients undergoing RUF repair between January 1, 1998 and February 28, 2015, at a single institution. All RUF were repaired using an anterior transperineal approach with an interposition muscle flap and selective use of a buccal mucosa graft onlay. RESULTS: Ninety-eight patients underwent repair with an anterior transperineal approach and muscle interposition flap (49 non-radiation induced and 49 radiation or ablation induced). Thirty- and 90-day complication rates were 29% and 2%, respectively, for non-radiated RUF, and 29% and 24%, respectively, for radiated RUF. Urethral diverticula, urinary incontinence, urethral stricture, and bowel problems were delayed complications requiring surgery. At a median follow-up of 14.5 months (range 3-144), 98% (48 of 49) of non-radiated RUF were closed with 1 procedure, whereas 86% (42 of 49) of radiated RUF were closed with 1 procedure. Gastrointestinal tract continuity was restored in 94% (45 of 48) of non-radiated RUF and in 65% (30 of 46) of radiated RUF. CONCLUSION: Successful RUF closure is possible in 98% of non-radiated and in 86% of radiated or ablated patients with 1 procedure. Most radiation-induced RUF, regardless of size, can be successfully repaired with minimal short-term complications. Delayed complications may arise and require surgery, and thus continued surveillance is recommended.
Authors: Sébastien Bergerat; François Rozet; Eric Barret; José Batista da Costa; Adalberto Castro; Paolo Dell'oglio; Marc Galiano; Alexandre Ingels; Rafael Sanchez Salas; Xavier Cathelineau Journal: World J Urol Date: 2018-02-13 Impact factor: 4.226
Authors: Javier C Angulo; Ignacio Arance; Yannick Apesteguy; João Felicio; Natália Martins; Francisco E Martins Journal: Int Braz J Urol Date: 2021 Mar-Apr Impact factor: 1.541