title: Twenty-year experience with surgical management of recto-urinary fistulas by posterior sagittal transrectal approach (York-Mason).
abstract: BACKGROUND
  We describe our 20-year experience with a posterior transrectal approach (York-Mason procedure) to treat recto-urinary fistula (RUF). Most RUFs are secondary to lower urinary or intestinal tract surgery. Spontaneous closure is infrequent, and operative treatment is often mandatory. Several surgical approaches have been proposed.
  
  
  METHODS
  We reviewed retrospectively the medical records of 14 patients presenting with RUF in our Department between 1988 and 2010. In 10 patients, RUFs developed after radical retropubic prostatectomy (RRP); in the other 4 patients, RUFs resulted after other surgical interventions. All patients were treated with the York-Mason approach. A temporary colostomy and suprapubic cystostomy were performed in all patients except one.
  
  
  RESULTS
  All patients were treated successfully. After fistulectomy, colostomies were closed after 4 mo, and patients reported fecal continence and no postoperative anal strictures. The colostomy was left in place permanently in 1 patient due to the simultaneous presence of Crohn's disease, in another with ulcerative rectocolitis, and in a third scheduled for adjuvant radiotherapy for relapse after RRP. In 1 patient, daily medications were essential because of wound infection. In the patient with Crohn's disease, the fistula recurred 11 years after first repair. Two patients died of metastatic prostate cancer 1 year after repair of the RUF.
  
  
  CONCLUSIONS
  The posterior sagittal transrectal approach allows easy access and good surgical exposure, facilitating identification of the fistulous tract. In our opinion, the York-Mason approach guarantees the greatest success rate with the least morbidity.
authors: Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Italy.
authors: Fabrizio
authors: F
authors: Dal Moro
authors: Silvia
authors: S
authors: Secco
authors: Claudio
authors: C
authors: Valotto
authors: Mariangela
authors: M
authors: Mancini
authors: Paolo
authors: P
authors: Beltrami
authors: Filiberto
authors: F
authors: Zattoni
mesh_terms: D000230:Adenocarcinoma / Q000150:complications; D003125:Colostomy; D003424:Crohn Disease / Q000150:complications; D003559:Cystostomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000150:complications; D020127:Recovery of Function; D012003:Rectal Fistula / Q000145:classification / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D012509:Sarcoma / Q000150:complications; D014548:Urinary Fistula / Q000145:classification / Q000150:complications / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*