title: Management of rectourinary fistula after urological interventions using biodesigned mesh: first experiences of an innovative technique.
abstract: OBJECTIVE
  Rectourinary fistula (RUF) is an uncommon but devastating condition that usually occurs as a complication of surgical treatment or radiotherapy of prostate cancer. Although operative fistula repair remains the most successful treatment, there still is no consensus concerning the management of RUF. We present first experiences and transanal surgical technique using biological mesh for fistula repair after urological intervention.
  
  
  METHODS
  From January 2009 to December 2013, four cases of RUF were reported at our university hospital. Fistula occurred after extraperitoneal laparoscopic radical prostatectomy, open radical prostatectomy, and high-intensity focused ultrasound, respectively. All patients were initially treated with transanal Cook Biodesign™ mesh, whereas two patients received reoperation with rectal mucosa advancement flap and gracilis muscle flap interposition, respectively. Mean follow-up was 36 months (range 9-62).
  
  
  RESULTS
  Fistula diameters ranged from 0.6 to 3.0 cm and were located 5 to 6 cm of anocutaneous line. The time from diagnosis to fistula repair was 3 to 7 weeks. The median operative time for Cook Biodesing™ mesh procedure was 79 min (IQR 60, 98). The initial success rate for biological mesh was 50 % (2/4 patients). Larger fistulae were minimalized successfully and finally closed with reoperation mentioned above. No deterioration of continence was documented.
  
  
  CONCLUSIONS
  Management of rectourinary fistula is still challenging. Using biomaterials for fistula closure seems to be a promising and minimally invasive transanal technique in future. Further analysis including more patients is needed to clarify its exact role in comparison to traditional surgical techniques.
authors.affiliation: St. Josef Medical Center, Department of Urology, University of Regensburg, Landshuter Strasse 65, 93053, Regensburg, Germany. Michael.Gierth@klinik.uni-regensburg.de.
authors.forename: M
authors.initials: M
authors.lastname: Gierth
authors.affiliation: St. Josef Medical Center, Department of Urology, University of Regensburg, Landshuter Strasse 65, 93053, Regensburg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Denzinger
authors.affiliation: Department of Surgery, St. Josef Medical Center Regensburg, Regensburg, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Liebig-Hörl
authors.affiliation: St. Josef Medical Center, Department of Urology, University of Regensburg, Landshuter Strasse 65, 93053, Regensburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Burger
authors.affiliation: Department of Surgery, St. Josef Medical Center Regensburg, Regensburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Fürst
mesh_terms: D000368:Aged; D001672:Biocompatible Materials; D004867:Equipment Design; D005500:Follow-Up Studies; D057086:High-Intensity Focused Ultrasound Ablation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012003:Rectal Fistula / Q000209:etiology / Q000601:surgery*; D013524:Surgical Flaps; D013526:Surgical Mesh; D014548:Urinary Fistula / Q000209:etiology / Q000601:surgery*
chemical_list: D001672:Biocompatible Materials
keywords: Biomaterial; Mesh; Radical prostatectomy; Rectourinary fistula; Transanal surgery