[Treatment of a rectourethral fistula after radical prostatectomy by York Mason posterior trans-sphincter exposure].
BACKGROUND
Recto-urethral fistula is an uncommon complication after radical prostatectomy, occurring in less than 2% of patients. Our aim is to review our experience for repairing these fistulas with the posterior trans-sphincter approach of York Mason.


METHODS
Retrospective review. All patients who underwent repair of postoperative recto-urethral fistula in our unit were included. The procedure described by York Mason was performed in all cases.


RESULTS
During the last 6 years, 5 patients with recto-urethral fistulas after radical prostatectomy were repaired by using this method. Symptoms, including faecaluria and/or passing of urine via the anus, appeared between the postoperative day 4 and 7 weeks after surgery, and confirmation was obtained by cystography. Initial faecal diversion with sigmoid loop colostomy was performed in 3 cases, whereas in the other 2 patients a loop ileostomy was performed at the time of surgical repair. The posterior trans- sphincter approach and fistula repair was performed between 5 and 10 months after diagnosis. Morbidity included wound infection in 2 cases and skin dehiscence in another 2 patients. Successful fistula closure was achieved in all cases with complete faecal continence. No recurrence has been observed after a mean follow-up of 22 (4-40) months.


CONCLUSIONS
The posterior trans-sphincter approach of York Mason is effective for the repair of recto-urethral fistulas after radical prostatectomy with minor morbidity and no impairment of continence.
Pera
Miguel
M
Unidad de Cirugía Colorrectal, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Mar, Barcelona, Spain. mpera@imas.imim.es
Alonso
Sandra
S
Parés
David
D
Lorente
José Antonio
JA
Bielsa
Oscar
O
Pascual
Marta
M
Courtier
Ricard
R
Gil
M José
MJ
Grande
Luis
L
D000368:Aged; D001003:Anal Canal; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods*; D012003:Rectal Fistula / Q000150:complications* / Q000601:surgery*; D012189:Retrospective Studies; D014548:Urinary Fistula / Q000150:complications* / Q000601:surgery*