M Zuin1,2, M Ruperto3, M Balduino3, A Amodeo4, L De Zorzi4, B Roche5, M Pavanello6, C Sernagiotto6. 1. Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università degli Studi di Padova, Clinica Chirurgica 1, Via Giustiniani 2, Padova, 35128, Italy. matteo.zuin@yahoo.it. 2. Clinica Chirurgica I, Azienda Ospedaliera di Padovavia Giustiniani, 35128, Padua, Italy. matteo.zuin@yahoo.it. 3. U.O.C. Chirurgia Generale, Ospedale San Giacomo - ULSS 2, Castelfranco Veneto, Italy. 4. IOV I.R.C.C.S, U.O.C. Urologia, Castelfranco Veneto, Italy. 5. Division of Visceral Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland. 6. Ospedale di Conegliano Veneto - ULSS 2, U.O.C. Chirurgia Generale, Conegliano, Italy.
Abstract
BACKGROUND: Rectourethral fistula (RUF) is a rare but significant complication after radical prostatectomy. Many different approaches have been used, but none of them has become the standard of care. METHODS: We present our series of seven patients treated with a transanal rectal advancement flap plus the injection of mesenchymal stem cells, to facilitate the healing of the fistula. Mesenchymal cells were obtained by a new mechanical device known as LIPOGEMS®. We called this technique RAFAL (rectal advancement flap plus adipose lipofilling). In all patients the RUF was a complication of laparoscopic radical prostatectomy. Fistula size ranged from 0.3 to 0.5 cm (median 0.4 cm). RESULTS: After a median follow-up of 53 months (range 6-163 months), 2 out of 7 patients experienced RUF recurrence. In both cases recurrence was successfully treated by the York-Mason technique in one case and by redo RAFAL in the other. Success rate of RAFAL was 71% (5 of 7). The total success rate of primary RAFAL and redo- RAFAL was 85.7% (6 of 7). No short- or long-term complications were seen. CONCLUSIONS: In our patient population this new procedure was safe and effective.
BACKGROUND: Rectourethral fistula (RUF) is a rare but significant complication after radical prostatectomy. Many different approaches have been used, but none of them has become the standard of care. METHODS: We present our series of seven patients treated with a transanal rectal advancement flap plus the injection of mesenchymal stem cells, to facilitate the healing of the fistula. Mesenchymal cells were obtained by a new mechanical device known as LIPOGEMS®. We called this technique RAFAL (rectal advancement flap plus adipose lipofilling). In all patients the RUF was a complication of laparoscopic radical prostatectomy. Fistula size ranged from 0.3 to 0.5 cm (median 0.4 cm). RESULTS: After a median follow-up of 53 months (range 6-163 months), 2 out of 7 patients experienced RUF recurrence. In both cases recurrence was successfully treated by the York-Mason technique in one case and by redo RAFAL in the other. Success rate of RAFAL was 71% (5 of 7). The total success rate of primary RAFAL and redo- RAFAL was 85.7% (6 of 7). No short- or long-term complications were seen. CONCLUSIONS: In our patient population this new procedure was safe and effective.
Authors: Christian Thomas; Jon Jones; Wolfgang Jäger; Christian Hampel; Joachim W Thüroff; Rolf Gillitzer Journal: J Urol Date: 2009-12-16 Impact factor: 7.450
Authors: L De Girolamo; M F Sartori; E Arrigoni; L Rimondini; W Albisetti; R L Weinstein; A T Brini Journal: Int J Artif Organs Date: 2008-06 Impact factor: 1.595