The York-Mason technique for recto-urethral fistulas.
OBJECTIVE
Recto-urethral fistula formation following radical prostatectomy is an uncommon but potentially devastating event. There is no consensus in the literature regarding the treatment of these fistulas. We present here our experiences treating recto-urethral fistulas.


METHODS
We analyzed 8 cases of rectourethral fistula treated at our institution in the last seven years. Seven of the patients underwent repair of the fistula using the modified York-Mason procedure.


RESULTS
The causes of the fistula were radical retropubic prostatectomy in five patients, perineal debridement of Fournier's gangrene in one, transvesical prostatectomy in one and transurethral resection of the prostate in the other patient. The most common clinical manifestation was fecaluria, present in 87.5% of the cases. The mean time elapsed between diagnosis and correction of the fistula was 29.6 (7-63) months. One spontaneous closure occurred after five months of delayed catheterization. Urinary and retrograde urethrocystography indicated the site of the fistula in 71.4% of the cases. No patient presented recurrence of the fistula after its correction with the modified York-Mason procedure.


CONCLUSIONS
The performance of routine colostomy and cystostomy is unnecessary. The technique described by York-Mason permits easy access, reduces surgical and hospitalization times and presents low complication and morbidity rates when surgically correcting recto-urethral fistulas.
Crippa
Alexandre
A
Department of Surgery, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil. drcrippa@uol.com.br
Dall'oglio
Marcos F
MF
Nesrallah
Luciano J
LJ
Hasegawa
Endric
E
Antunes
Alberto Azoubel
AA
Srougi
Miguel
M
D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects; D012003:Rectal Fistula / Q000209:etiology / Q000601:surgery*; D012008:Recurrence; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014522:Urethral Diseases / Q000209:etiology / Q000601:surgery*; D014548:Urinary Fistula / Q000209:etiology / Q000601:surgery*