title: Rectourethral Fistulas Secondary to Prostate Cancer Treatment: Management and Outcomes from a Multi-Institutional Combined Experience.
abstract: Rectourethral fistula is a known complication of prostate cancer treatment. Reports in the literature on rectourethral fistula repair technique and outcomes are limited to single institution series. We examined the variations in technique and outcomes of rectourethral fistula repair in a multi-institutional setting.
  
  
  
  We retrospectively identified patients who underwent rectourethral fistula repair after prostate cancer treatment at 1 of 4 large volume reconstructive urology centers, including University of California-San Francisco, University College London Hospitals, Lahey Clinic and Devine-Jordan Center for Reconstructive Surgery, in a 15-year period. We examined the types of prostate cancer treatment, technical aspects of rectourethral fistula repair and outcomes.
  
  
  
  After prostate cancer treatment 201 patients underwent rectourethral fistula repair. The fistula developed in 97 men (48.2%) after radical prostatectomy alone and in 104 (51.8%) who received a form of energy ablation. In the ablation group 84% of patients underwent bowel diversion before rectourethral fistula repair compared to 65% in the prostatectomy group. An interposition flap or graft was placed in 91% and 92% of the 2 groups, respectively. Concomitant bladder neck contracture or urethral stricture developed in 26% of patients in the ablation group and in 14% in the prostatectomy group. Postoperatively the rates of urinary incontinence and complications were higher in the energy ablation group at 35% and 25% vs 16% and 11%, respectively. The ultimate success rate of fistula repair in the energy ablation and radical prostatectomy groups was 87% and 99% with 92% overall success.
  
  
  
  Rectourethral fistulas due to prostate cancer therapy can be reconstructed successfully in a high percent of patients. This avoids permanent urinary diversion in these complex cases.
authors.forename: Catherine R
authors.initials: CR
authors.lastname: Harris
authors.forename: Jack W
authors.initials: JW
authors.lastname: McAninch
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Mundy
authors.forename: Leonard N
authors.initials: LN
authors.lastname: Zinman
authors.forename: Gerald H
authors.initials: GH
authors.lastname: Jordan
authors.forename: Daniela
authors.initials: D
authors.lastname: Andrich
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Vanni
authors.forename: Ramón
authors.initials: R
authors.lastname: Virasoro
authors.forename: Benjamin N
authors.initials: BN
authors.lastname: Breyer
mesh_terms: D000368:Aged; D002140:California; D015331:Cohort Studies; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D011788:Quality of Life; D011878:Radiotherapy / Q000009:adverse effects* / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012003:Rectal Fistula / Q000209:etiology* / Q000601:surgery; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014548:Urinary Fistula / Q000209:etiology* / Q000601:surgery
keywords: fistula; high-intensity focused ultrasound ablation; prostatectomy; prostatic neoplasms; urethra