title: Transanal endoscopic microsurgery for surgical repair of rectovesical fistula following radical prostatectomy.
abstract: BACKGROUND
  Rectovesical fistula is a rare complication following prostatectomy, associated with significant symptoms such as urinary drainage from anus or faecaluria. While several surgical procedures have been described to treat this condition, none of them has been accepted as the universal standard. Transanal endoscopic microsurgery (TEM) is a well-established endoluminal procedure for local excision of rectal tumors. But its application to the repair of rectovesical fistula has been almost unknown.
  
  
  METHODS
  We performed TEM as a surgical repair for refractory rectovesical fistula developing after radical prostatectomy in 10 patients. Under the magnified three-dimensional view, through the stereoscope, the fistula and the surrounding rectal mucosa were precisely resected. The defect and the muscle layer of the rectum were closed by hand-sew technique in four layers.
  
  
  RESULTS
  Fistula was completely closed in 7 patients, who eventually underwent enterostomy closure, while in the other 3 patients the fistula recurred. In the three recurrent cases, the fistula was associated with wide, tough scar tissue due to previous irradiation, HIFU, or repeated surgical repair attempts.
  
  
  CONCLUSIONS
  Rectovesical fistulas associated with wide, tough scar tissue due to multi-time attempt of surgical repair or any type of energy ablation should not be indicated for repair by TEM. However, for simple fistulas without tough, fibrotic surroundings, TEM can be indicated as a minimally invasive surgical option with very low morbidity, without any incision in healthy tissue for approach.
authors: Department of Surgery, Medical Topia Soka, 1-11-18 Yatsuka, Soka, Saitama, 340 0028, Japan, kanehira@mtopia.jp.
authors: Eiji
authors: E
authors: Kanehira
authors: Takashi
authors: T
authors: Tanida
authors: Aya
authors: A
authors: Kamei
authors: Masafumi
authors: M
authors: Nakagi
authors: Mitsuharu
authors: M
authors: Iwasaki
authors: Hirofumi
authors: H
authors: Shimizu
mesh_terms: D000368:Aged; D001003:Anal Canal; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D011183:Postoperative Complications / Q000601:surgery*; D011468:Prostatectomy / Q000379:methods; D012003:Rectal Fistula / Q000209:etiology / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D016896:Treatment Outcome; D001747:Urinary Bladder Fistula / Q000209:etiology / Q000601:surgery*