title: Gracilis Muscle Interposition for Rectourethral Fistula After Laparoscopic Prostatectomy: A Prospective Evaluation and Long-term Follow-up.
abstract: BACKGROUND
  Postoperative rectourethral fistula after radical prostatectomy is an infrequent but very serious problem.
  
  
  OBJECTIVE
  We aimed to describe our experience with transperineal repair and unilateral gracilis muscle interposition in patients with rectourethral fistula after radical prostatectomy in nonradiated prostate cancer.
  
  
  METHODS
  This was a cohort study.
  
  
  METHODS
  All of the procedures were performed at the same hospital by the same multidisciplinary team made up of a senior colorectal surgeon and a senior urologist.
  
  
  METHODS
  Patients with postoperative rectourethral fistula after laparoscopic prostatectomy were included.
  
  
  METHODS
  Transperineal fistula repair and gracilis muscle interposition were included.
  
  
  METHODS
  Fistula healing rate was measured.
  
  
  RESULTS
  Nine patients with postoperative rectourethral fistula were treated between November 2009 and February 2016. Four of them had received other previous treatments without success, and 5 had previously been treated with this technique. Seven patients had a fecal diverting stoma. After a median follow-up of 54 months (range, 2-72), all of the fistulas had successfully healed, and, to date, the patients remain asymptomatic without urinary diversion. Fecal diversion was closed in all but 1 patient. No intraoperative or infectious complications were detected. With the results of our series, we present specific technical details of our technique and hope to provide additional evidence of the low morbidity profile and excellent healing rate of this treatment. Moreover, we note that, although small, this series corresponds with a homogeneous group of patients with rectourethral fistula after radical prostatectomy in nonradiated prostate cancer.
  
  
  CONCLUSIONS
  This is a small but very homogeneous group of patients.
  
  
  CONCLUSIONS
  Simple repair with perineal gracilis muscle interposition is a safe and effective technique for the treatment of postoperative rectourethral fistulas after nonradiated prostate cancer surgery.
authors.affiliation: 1 Unit of Colorectal Surgery, Department of General Surgery, Hospital Universitari MútuaTerrassa, Universitat de Barcelona, Barcelona, Spain 2 Department of Urology, Hospital Universitari MútuaTerrassa, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Arantxa
authors.initials: A
authors.lastname: Muñoz-Duyos
authors.forename: Albert
authors.initials: A
authors.lastname: Navarro-Luna
authors.forename: Fernando
authors.initials: F
authors.lastname: Pardo-Aranda
authors.forename: Josep M
authors.initials: JM
authors.lastname: Caballero
authors.forename: Pere
authors.initials: P
authors.lastname: Borrat
authors.forename: Carles
authors.initials: C
authors.lastname: Maristany
authors.forename: José A
authors.initials: JA
authors.lastname: Pando
authors.forename: Enrique
authors.initials: E
authors.lastname: Veloso
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005500:Follow-Up Studies; D000071976:Gracilis Muscle / Q000637:transplantation*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D011446:Prospective Studies; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000601:surgery*; D012003:Rectal Fistula / Q000601:surgery*; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome; D014522:Urethral Diseases / Q000601:surgery*; D014548:Urinary Fistula / Q000601:surgery*