title: Transperineal repair of a persistent rectourethral fistula using a porcine dermal graft.
abstract: BACKGROUND
  Rectourethral fistula (RUF) is a rare major complication after radical prostatectomy (RP). Management of patients with persistent RUFs after primary repair is controversial and technically challenging.
  
  
  METHODS
  We describe the case of a patient with history of RUF secondary to rectal injury during laparoscopic RP and failed trans-abdominal repair. A further attempt to repair the persistent RUF was done through a perineal approach. The fistula was excised, the anterior rectal wall was closed in two layers and the defect at the level of the urethrovesical anastomosis (UVA) was repaired with an interrupted suture. A porcine dermal graft was interposed between the UVA and the rectum and was sutured to the rectal wall. There were neither clinical nor radiological evidences of fistula recurrence at one-year follow-up after transperineal surgical repair.
  
  
  CONCLUSIONS
  We used, for the first time, a porcine dermal collagen allograft as interposition tissue in a persistent RUF secondary to rectal injury during laparoscopic RP. The use of this allograft allows the potential advantage of less surgical invasivity if compared to gracilis muscle graft.
  
  
  CONCLUSIONS
  Transperineal repair of persistent RUFs with porcine dermal graft interposition is a safe and feasible surgical procedure.
authors.affiliation: Urologic Unit, Buon Consiglio Fatebenefratelli Hospital, Via Manzoni 220, 80123 Naples, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Imperatore
authors.affiliation: Urologic Unit, Buon Consiglio Fatebenefratelli Hospital, Via Manzoni 220, 80123 Naples, Italy. Electronic address: max.creta@gmail.com.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Creta
authors.affiliation: Urologic Unit, Buon Consiglio Fatebenefratelli Hospital, Via Manzoni 220, 80123 Naples, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Di Meo
authors.affiliation: Urologic Unit, Buon Consiglio Fatebenefratelli Hospital, Via Manzoni 220, 80123 Naples, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Buonopane
authors.affiliation: Urology Department, University Federico II of Naples, Via S.Pansini 5, 80131 Naples, Italy.
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Fusco
authors.affiliation: Urology Department, University Federico II of Naples, Via S.Pansini 5, 80131 Naples, Italy.
authors.forename: Ciro
authors.initials: C
authors.lastname: Imbimbo
authors.affiliation: Urology Department, University Federico II of Naples, Via S.Pansini 5, 80131 Naples, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Longo
authors.affiliation: Urology Department, University Federico II of Naples, Via S.Pansini 5, 80131 Naples, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Mirone
keywords: Radical prostatectomy; Rectourethral fistula