Transanal repair of rectourethral fistula after a radical retropubic prostatectomy: report of a case.
Rectourethral fistula occurred in a 64-year-old man after a radical prostatectomy. Despite conservative treatment the fistula did not close spontaneously. Eleven months after the original prostatectomy, an operation was performed. We chose the Latzko technique with slight modifications as follows. The patient was placed in the prone jackknife position. The fistula was found at a site about 6.0 cm from the anal verge. An elliptical area of rectal mucosa was incised about 1.5 cm from the fistulous orifice and subsequently the rectal mucosa was denuded. The submucosa was dissected above the fistula about 2.0 cm from the edge of the incision. The fistula was then closed with one layer of side-by-side absorbable 2-0 polyglactin sutures. The dissected rectal mucosal flap was brought down over the fistula and sutured in one layer to the distal edge of the rectal muscularis propria through the mucosa with 3-0 polyglactin sutures. On postoperative day 21 a retrograde urethrogram was made and it showed no leakage of urine via the rectum. This procedure is a simple, effective, and minimally morbid technique for the repair of rectourethral fistula after a radical prostatectomy, although it is only useful for the treatment of low rectourethral fistulas.
Hata
Fumitake
F
Department of Surgery, Sapporo Medical University School of Medicine, Japan.
Yasoshima
Takahiro
T
Kitagawa
Shingo
S
Furuhata
Tomohisa
T
Ohmura
Tousei
T
Nakajima
Futoshi
F
Honma
Toshio
T
Sogahata
Katsuya
K
Nomura
Hiroki
H
Nishimori
Hidefumi
H
Kutomi
Goro
G
Fukui
Rika
R
Ohno
Keisuke
K
Maeda
Tomomi
T
Hirata
Koichi
K
Tsukamoto
Taiji
T
D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects*; D012003:Rectal Fistula / Q000209:etiology / Q000601:surgery*; D014522:Urethral Diseases / Q000209:etiology / Q000601:surgery*; D014548:Urinary Fistula / Q000209:etiology / Q000601:surgery*