title: Experience in the treatment of rectourethral fistulae after radical prostatectomy.
abstract: OBJECTIVE
  To report the clinical characteristics of rectourethral fistula (RUF) after radical prostatectomy (RP) as well as our experience managing them.
  
  
  METHODS
  We present our experience in the treatment of RUF based on their clinical characteristics and the presence of associated complexity factors. After medical history and physical examination, the diagnostic work up was completed in all cases with urethrograms, cystoscopy and barium enema. From January 2000 to July 2010 we treated 12 patients with RUF. Mean age was 64 years(range 56-74 years). The etiology was open surgery in two cases and laparoscopic surgery in ten. Clinical presentation varied from 4 to 60 days after surgery.
  
  
  RESULTS
  In our experience, endoscopic and radiological findings were well correlated. Two fistulae were small-less than 5 mm- on the urethral side of the anastomosis allowing spontaneous closure after conservative treatment. Ten patients had larger fistulas on the bladder side of the anastomosis and/or were associated with complexity factors that required a posterior transsphincteric York-Mason approach for resolution, with good recovery of urinary and fecal continence.
  
  
  CONCLUSIONS
  The RUF is a significant complication after RP and it is difficult to solve. We propose early reconstructive surgery in large or complex RUF. The posterior transsphincteric York-Mason approach has allowed the repair in all cases.
authors.affiliation: Urology Department, Unit of Colo-Rectal Surgery, Parc de Salut de Barcelona, Hospital del Mar, Spain. jlorente@parcdesalutmar.cat
authors.forename: José A
authors.initials: JA
authors.lastname: Lorente
authors.forename: Oscar
authors.initials: O
authors.lastname: Bielsa
authors.forename: Enrique
authors.initials: E
authors.lastname: Rijo
authors.forename: Albert
authors.initials: A
authors.lastname: Francés
authors.forename: Miguel
authors.initials: M
authors.lastname: Pera
authors.forename: Octavio
authors.initials: O
authors.lastname: Arango
mesh_terms: D000368:Aged; D005242:Fecal Incontinence / Q000209:etiology / Q000628:therapy; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*; D011468:Prostatectomy / Q000009:adverse effects*; D020127:Recovery of Function; D012003:Rectal Fistula / Q000209:etiology* / Q000628:therapy*; D012189:Retrospective Studies; D014522:Urethral Diseases / Q000209:etiology / Q000628:therapy*; D014548:Urinary Fistula / Q000209:etiology* / Q000628:therapy*; D014549:Urinary Incontinence / Q000209:etiology / Q000628:therapy