Short-term outcomes of the surgical management of acquired rectourethral fistulas

Does technique matter?

Valentine N Nfonsam, James J L Mateka, Andrew D. Prather, Jorge E. Marcet

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Acquired rectourethral fistulas are uncommon and challenging to repair. Most arise as a complication of prostate cancer treatment. Several procedures have been described to repair rectourethral fistulas with varying outcomes. We review the etiology, management, and outcomes of patients with rectourethral fistulas at our institution. Materials and methods: A retrospective review of patients undergoing repair of rectourethral fistulas was undertaken. Data were collected on patient demographics, fistula etiology, operative procedure, fecal and urinary diversion, and clinical outcome. Patients with urinary and/or fecal diversion underwent radiographic evaluation to confirm closure of the fistula prior to reversal of the diversion. Results: Fistula repair was performed on 22 patients from 1999 to 2009. All the patients were male of an average age of 69 years (range: 39-82 years). All patients, except one, had prostate cancer. Fistula formation was associated with radiotherapy in 54.4% of patients, brachytherapy in 36.4% of patients, and with external beam radiation therapy in 18.2% of patients. Other causes included prostatectomy (seven patients, 31.8%), cryotherapy (two patients, 9.1%), and perianal abscess (one patient, 4.5%). Procedures performed for fistula repair included transanal repair (eleven patients, 50%), transperineal repair (five patients, 22.7%), transabdominal repair (three patients, 13.6%), and York-Mason repair (three patients, 13.6%). Fourteen patients (63.6%) had urinary diversion. Fecal diversion was performed in 16 (72.7%) patients. Five (22.7%) patients had had previous attempts at fistula repair. Of the 22 patients treated, repair was successful in 20 patients (91%). The average follow-up time was 6 months (range: 3-13 months). Conclusion: The success rate of treatment of rectourethral fistulas is high, regardless of the procedure type. Patients with previous repair attempts tend to have less favorable outcomes. With high success rates, less invasive procedures should be attempted first.

Original languageEnglish (US)
Pages (from-to)47-51
Number of pages5
JournalResearch and Reports in Urology
Volume5
StatePublished - Jan 29 2013

Fingerprint

Fistula
Urinary Diversion
Prostatic Neoplasms
Radiotherapy
Cryotherapy
Operative Surgical Procedures
Brachytherapy

Keywords

  • Cancer
  • Colostomy
  • Fistula
  • Management
  • Prostate
  • Radiation
  • Rectourethral
  • Transanal
  • Transperineal
  • York-Mason

ASJC Scopus subject areas

  • Urology

Cite this

Short-term outcomes of the surgical management of acquired rectourethral fistulas : Does technique matter? / Nfonsam, Valentine N; Mateka, James J L; Prather, Andrew D.; Marcet, Jorge E.

In: Research and Reports in Urology, Vol. 5, 29.01.2013, p. 47-51.

Research output: Contribution to journalArticle

@article{bdee58f440524a6cab0626bb91114cd7,
title = "Short-term outcomes of the surgical management of acquired rectourethral fistulas: Does technique matter?",
abstract = "Background: Acquired rectourethral fistulas are uncommon and challenging to repair. Most arise as a complication of prostate cancer treatment. Several procedures have been described to repair rectourethral fistulas with varying outcomes. We review the etiology, management, and outcomes of patients with rectourethral fistulas at our institution. Materials and methods: A retrospective review of patients undergoing repair of rectourethral fistulas was undertaken. Data were collected on patient demographics, fistula etiology, operative procedure, fecal and urinary diversion, and clinical outcome. Patients with urinary and/or fecal diversion underwent radiographic evaluation to confirm closure of the fistula prior to reversal of the diversion. Results: Fistula repair was performed on 22 patients from 1999 to 2009. All the patients were male of an average age of 69 years (range: 39-82 years). All patients, except one, had prostate cancer. Fistula formation was associated with radiotherapy in 54.4{\%} of patients, brachytherapy in 36.4{\%} of patients, and with external beam radiation therapy in 18.2{\%} of patients. Other causes included prostatectomy (seven patients, 31.8{\%}), cryotherapy (two patients, 9.1{\%}), and perianal abscess (one patient, 4.5{\%}). Procedures performed for fistula repair included transanal repair (eleven patients, 50{\%}), transperineal repair (five patients, 22.7{\%}), transabdominal repair (three patients, 13.6{\%}), and York-Mason repair (three patients, 13.6{\%}). Fourteen patients (63.6{\%}) had urinary diversion. Fecal diversion was performed in 16 (72.7{\%}) patients. Five (22.7{\%}) patients had had previous attempts at fistula repair. Of the 22 patients treated, repair was successful in 20 patients (91{\%}). The average follow-up time was 6 months (range: 3-13 months). Conclusion: The success rate of treatment of rectourethral fistulas is high, regardless of the procedure type. Patients with previous repair attempts tend to have less favorable outcomes. With high success rates, less invasive procedures should be attempted first.",
keywords = "Cancer, Colostomy, Fistula, Management, Prostate, Radiation, Rectourethral, Transanal, Transperineal, York-Mason",
author = "Nfonsam, {Valentine N} and Mateka, {James J L} and Prather, {Andrew D.} and Marcet, {Jorge E.}",
year = "2013",
month = "1",
day = "29",
language = "English (US)",
volume = "5",
pages = "47--51",
journal = "Research and Reports in Urology",
issn = "1179-1551",
publisher = "Dove Medical Press Limited",

}

TY - JOUR

T1 - Short-term outcomes of the surgical management of acquired rectourethral fistulas

T2 - Does technique matter?

AU - Nfonsam, Valentine N

AU - Mateka, James J L

AU - Prather, Andrew D.

AU - Marcet, Jorge E.

PY - 2013/1/29

Y1 - 2013/1/29

N2 - Background: Acquired rectourethral fistulas are uncommon and challenging to repair. Most arise as a complication of prostate cancer treatment. Several procedures have been described to repair rectourethral fistulas with varying outcomes. We review the etiology, management, and outcomes of patients with rectourethral fistulas at our institution. Materials and methods: A retrospective review of patients undergoing repair of rectourethral fistulas was undertaken. Data were collected on patient demographics, fistula etiology, operative procedure, fecal and urinary diversion, and clinical outcome. Patients with urinary and/or fecal diversion underwent radiographic evaluation to confirm closure of the fistula prior to reversal of the diversion. Results: Fistula repair was performed on 22 patients from 1999 to 2009. All the patients were male of an average age of 69 years (range: 39-82 years). All patients, except one, had prostate cancer. Fistula formation was associated with radiotherapy in 54.4% of patients, brachytherapy in 36.4% of patients, and with external beam radiation therapy in 18.2% of patients. Other causes included prostatectomy (seven patients, 31.8%), cryotherapy (two patients, 9.1%), and perianal abscess (one patient, 4.5%). Procedures performed for fistula repair included transanal repair (eleven patients, 50%), transperineal repair (five patients, 22.7%), transabdominal repair (three patients, 13.6%), and York-Mason repair (three patients, 13.6%). Fourteen patients (63.6%) had urinary diversion. Fecal diversion was performed in 16 (72.7%) patients. Five (22.7%) patients had had previous attempts at fistula repair. Of the 22 patients treated, repair was successful in 20 patients (91%). The average follow-up time was 6 months (range: 3-13 months). Conclusion: The success rate of treatment of rectourethral fistulas is high, regardless of the procedure type. Patients with previous repair attempts tend to have less favorable outcomes. With high success rates, less invasive procedures should be attempted first.

AB - Background: Acquired rectourethral fistulas are uncommon and challenging to repair. Most arise as a complication of prostate cancer treatment. Several procedures have been described to repair rectourethral fistulas with varying outcomes. We review the etiology, management, and outcomes of patients with rectourethral fistulas at our institution. Materials and methods: A retrospective review of patients undergoing repair of rectourethral fistulas was undertaken. Data were collected on patient demographics, fistula etiology, operative procedure, fecal and urinary diversion, and clinical outcome. Patients with urinary and/or fecal diversion underwent radiographic evaluation to confirm closure of the fistula prior to reversal of the diversion. Results: Fistula repair was performed on 22 patients from 1999 to 2009. All the patients were male of an average age of 69 years (range: 39-82 years). All patients, except one, had prostate cancer. Fistula formation was associated with radiotherapy in 54.4% of patients, brachytherapy in 36.4% of patients, and with external beam radiation therapy in 18.2% of patients. Other causes included prostatectomy (seven patients, 31.8%), cryotherapy (two patients, 9.1%), and perianal abscess (one patient, 4.5%). Procedures performed for fistula repair included transanal repair (eleven patients, 50%), transperineal repair (five patients, 22.7%), transabdominal repair (three patients, 13.6%), and York-Mason repair (three patients, 13.6%). Fourteen patients (63.6%) had urinary diversion. Fecal diversion was performed in 16 (72.7%) patients. Five (22.7%) patients had had previous attempts at fistula repair. Of the 22 patients treated, repair was successful in 20 patients (91%). The average follow-up time was 6 months (range: 3-13 months). Conclusion: The success rate of treatment of rectourethral fistulas is high, regardless of the procedure type. Patients with previous repair attempts tend to have less favorable outcomes. With high success rates, less invasive procedures should be attempted first.

KW - Cancer

KW - Colostomy

KW - Fistula

KW - Management

KW - Prostate

KW - Radiation

KW - Rectourethral

KW - Transanal

KW - Transperineal

KW - York-Mason

UR - http://www.scopus.com/inward/record.url?scp=84884472055&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84884472055&partnerID=8YFLogxK

M3 - Article

VL - 5

SP - 47

EP - 51

JO - Research and Reports in Urology

JF - Research and Reports in Urology

SN - 1179-1551

ER -