title: Minimally Invasive Transanal Repair of Rectourethral Fistulas.
abstract: Rectourethral fistulas (RUFs) represent an uncommon complication of pelvic surgery, especially radical prostatectomy. To date there is no standardised treatment for managing RUFs. This represents a challenge for surgeons, mainly because of the potential recurrence risk.
  
  
  
  To describe our minimally invasive transanal repair (MITAR) of RUFs and to assess its safety and outcomes.
  
  
  
  We retrospectively evaluated 12 patients who underwent MITAR of RUF at our centre from October 2008 to December 2014. Exclusion criteria were a fistula diameter greater than 1.5cm, sepsis, and/or faecaluria.
  
  
  
  After fistula identification through cystoscopy and 5F-catheter positioning within the fistula, MITAR is performed using laparoscopic instruments introduced through Parks' anal retractor. The fibrotic margins of the fistula are carefully dissected by a lozenge incision of the rectal wall, parallel to the rectal axis. Under the healthy flap of the rectal wall the urothelium is located and the fistulous tract is sutured with interrupted stitches. After a leakage test of the bladder, the rectal wall is sutured with interrupted stitches. Electrocoagulation is never used during this procedure.
  
  
  
  Fistula closure, postoperative complications, and recurrence.
  
  
  
  Median follow-up was 21 (range, 12-74) mo. Median operative time was 58 (range, 50-70) min. Median hospital stay was 1.5 (range, 1-4) d. Early surgical complications occurred in one patient (8.3%). Recurrence did not occur in any of the cases. Limitations included retrospective analysis, small case load, and lack of experience with radiation-induced fustulas.
  
  
  
  MITAR is a safe, effective, and reproducible procedure. Its advantages are low morbidity and quick recovery, and no need for a colostomy.
  
  
  
  We studied the treatment of rectourethral fistulas. Our technique, transanally performed using laparoscopic instruments, was found to be safe, feasible, and effective, with limited risk of complications.
authors.affiliation: Department of Urology, University of Florence, Careggi Hospital, Florence, Italy. Electronic address: gnicita@unifi.it.
authors.forename: Giulio
authors.initials: G
authors.lastname: Nicita
authors.affiliation: Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
authors.forename: Donata
authors.initials: D
authors.lastname: Villari
authors.affiliation: Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Caroassai Grisanti
authors.affiliation: Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Marzocco
authors.affiliation: Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Li Marzi
authors.affiliation: Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Martini
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012003:Rectal Fistula / Q000209:etiology / Q000601:surgery*; D013524:Surgical Flaps; D000067368:Transanal Endoscopic Surgery / Q000379:methods*; D014522:Urethral Diseases / Q000209:etiology / Q000601:surgery*; D014548:Urinary Fistula / Q000209:etiology / Q000601:surgery*
keywords: Fistula treatment; Laparoscopic instruments; Minimally invasive surgery; Transanal approach