Transanal transrectal repair of rectourethral fistula utilizing a dartos flap interposition
Gjanje Smith, MD1, Shlomo Raz, MD2, Arthur Mourtzinos, MD1.
1Lahey Clinic Medical Center, Burlington, MA, USA, 2UCLA Medical Center, Los Angeles, CA, USA.
BACKGROUND: A rectourethral fistula is a rare complication after treatment for benign and malignant neoplasms of the prostate. Because of their location near the outlet of the pelvis, access to or exposure of these fistulas is quite limited. We present our experience with cases of complex rectourethral fistula repairs using a novel approach with a dartos flap interposition.
METHODS: From January 2008 to September 2008, three patients underwent repair of a rectourethral fistula utilizing a dartos flap interposition via a transanal transrectal approach at two academic institutions. The etiology was robotic-assisted prostatectomy for organ-confined prostate cancer. All patients presented with the passage of urine through the rectum and underwent voiding cystourethrography with retrograde urethrography, followed by preliminary cystoscopy and examination under anesthesia. Preoperatively, bowel diversion was done at the time of the cystourethroscopy and examination under anesthesia, if not done earlier, and the definitive repair was deferred for at least 12 weeks after bowel diversion. Their outcomes were assessed after surgical repair.
RESULTS: Rectourethral fistula repair was successful in all of the patients. Postoperatively there were no complications. All patients were completely continent of urine 5 months postoperatively. All patients underwent fecal undiversion at least 6 months postoperatively. To date, all patients are continent of stool after undiversion.
CONCLUSIONS: Rectourethral fistula closure utilizing a dartos flap interposition via a transanal transrectal approach is associated with low morbidity and a high success rate.