Successful repair of iatrogenic rectourinary fistulas using the posterior sagittal transrectal approach (York-Mason): 15-year experience.
BACKGROUND
Rectourinary fistulas (RUFs) represent a challenging clinical problem. Most RUFs are secondary to lower urinary or intestinal tract surgery. Several surgical approaches have been proposed. The aim of this study was to review a 15-year experience using the York-Mason posterior sagittal transrectal approach to iatrogenic RUFs.


METHODS
Seven patients with RUFs secondary to urologic surgery were operated on with the York-Mason technique at the Department of Urology, University of Padova, Italy between 1988 and 2003. The patients' data have been collected and analyzed retrospectively.


RESULTS
All the patients were treated successfully (100%). In one patient with Crohn's disease the fistula recurred 11 years after the first surgery. One patient died for metastasis of prostate cancer 1 year after surgical repair of the RUF. A temporary colostomy was performed in five patients; the colostomies were subsequently closed, and the patients regained complete fecal continence with no postoperative anal strictures. The colostomy remained in place in one patient with Crohn's disease and in another with ulcerative rectocolitis.


CONCLUSIONS
The posterior sagittal transrectal approach provided easy access and identification of RUFs and good surgical exposure, with no subsequent strictures or fecal incontinence. Our data show that the York-Mason technique alone is a highly effective option for treating an iatrogenic postoperative RUF.
Dal Moro
Fabrizio
F
Department of Urology, University of Padova Medical School, Via Giustiniani 2, Padova, I-35128, Italy. fabrizio.dalmoro@unipd.it
Mancini
Mariangela
M
Pinto
Francesco
F
Zanovello
Nicola
N
Bassi
Pier Francesco
PF
Pagano
Francesco
F
D000368:Aged; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects; D012003:Rectal Fistula / Q000601:surgery*; D012189:Retrospective Studies; D014548:Urinary Fistula / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*