M Binnebösel1, A Lambertz2, C D Klink2, U P Neumann2. 1. Klinik für Allgemein-, Viszeral und Transplantationschirurgie, Uniklinik der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland. mbinneboesel@ukaachen.de. 2. Klinik für Allgemein-, Viszeral und Transplantationschirurgie, Uniklinik der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
Abstract
BACKGROUND: Radiotherapy in the treatment of prostate cancer is well established. Intestinal complications following radiotherapy are divided into acute and chronic toxicity. Chronic complications like perforation and fistula formation to the rectum are rare and difficult to treat. MATERIALS AND METHODS: In case of chronic radiotherapy complications and particularly chronic fistula formation to the rectum, evidence is low. Therefore, an overview of the available literature of surgical therapy strategies is given. RESULTS: Options for the treatment of acute intestinal toxicity are established and therapy algorithms exist. Therapy of acute rectal perforation covers primary suture repair with or without diversion stoma as well as primary rectal resection with or without primary restoring bowel continuity. In chronic rectal lesions and particularly in fistula formation to the rectum, abdominal treatment strategies are preferred with additional interposition of an omental flap or vascularized muscle flap. CONCLUSION: Although evidence for surgical therapy strategies of the rare chronic rectourethral and rectovesical fistula is low, treatment is a real interdisciplinary challenge and should be provided in a specialized center.
BACKGROUND: Radiotherapy in the treatment of prostate cancer is well established. Intestinal complications following radiotherapy are divided into acute and chronic toxicity. Chronic complications like perforation and fistula formation to the rectum are rare and difficult to treat. MATERIALS AND METHODS: In case of chronic radiotherapy complications and particularly chronic fistula formation to the rectum, evidence is low. Therefore, an overview of the available literature of surgical therapy strategies is given. RESULTS: Options for the treatment of acute intestinal toxicity are established and therapy algorithms exist. Therapy of acute rectal perforation covers primary suture repair with or without diversion stoma as well as primary rectal resection with or without primary restoring bowel continuity. In chronic rectal lesions and particularly in fistula formation to the rectum, abdominal treatment strategies are preferred with additional interposition of an omental flap or vascularized muscle flap. CONCLUSION: Although evidence for surgical therapy strategies of the rare chronic rectourethral and rectovesical fistula is low, treatment is a real interdisciplinary challenge and should be provided in a specialized center.
Authors: Daher C Chade; James Eastham; Markus Graefen; Jim C Hu; R Jeffrey Karnes; Laurence Klotz; Francesco Montorsi; Hendrik van Poppel; Peter T Scardino; Shahrokh F Shariat Journal: Eur Urol Date: 2012-01-23 Impact factor: 20.096
Authors: Christian D Klink; Kosta Lioupis; Marcel Binnebösel; Daniel Kaemmer; Ivanna Kozubek; Jochen Grommes; Ulf P Neumann; Marc Jansen; Stefan Willis Journal: Int J Colorectal Dis Date: 2011-01-11 Impact factor: 2.571
Authors: Nasiruddin Mohammed; Larry Kestin; Mihai Ghilezan; Daniel Krauss; Frank Vicini; Donald Brabbins; Gary Gustafson; Hong Ye; Alavaro Martinez Journal: Int J Radiat Oncol Biol Phys Date: 2010-12-16 Impact factor: 7.038
Authors: Vladimir Yutkin; Hashim U Ahmed; Ian Donaldson; Neil McCartan; Khurram Siddiqui; Mark Emberton; Joseph L Chin Journal: Urology Date: 2014-10-24 Impact factor: 2.649
Authors: Eugene H Huang; Alan Pollack; Larry Levy; George Starkschall; Lei Dong; Isaac Rosen; Deborah A Kuban Journal: Int J Radiat Oncol Biol Phys Date: 2002-12-01 Impact factor: 7.038
Authors: Andrew J Stephenson; Peter T Scardino; Fernando J Bianco; Christopher J DiBlasio; Paul A Fearn; James A Eastham Journal: J Urol Date: 2004-12 Impact factor: 7.450