[Treatment of a rectourethral fistula after radical prostatectomy by York Mason posterior trans-sphincter exposure]

Abstract

Introduction: Recto-urethral fistula is an uncommon complication after radical prostatectomy, occurring in less than 2% of patients. Our aim is to review our experience for repairing these fistulas with the posterior trans-sphincter approach of York Mason.

Patients and method: Retrospective review. All patients who underwent repair of postoperative recto-urethral fistula in our unit were included. The procedure described by York Mason was performed in all cases.

Results: During the last 6 years, 5 patients with recto-urethral fistulas after radical prostatectomy were repaired by using this method. Symptoms, including faecaluria and/or passing of urine via the anus, appeared between the postoperative day 4 and 7 weeks after surgery, and confirmation was obtained by cystography. Initial faecal diversion with sigmoid loop colostomy was performed in 3 cases, whereas in the other 2 patients a loop ileostomy was performed at the time of surgical repair. The posterior trans- sphincter approach and fistula repair was performed between 5 and 10 months after diagnosis. Morbidity included wound infection in 2 cases and skin dehiscence in another 2 patients. Successful fistula closure was achieved in all cases with complete faecal continence. No recurrence has been observed after a mean follow-up of 22 (4-40) months.

Conclusions: The posterior trans-sphincter approach of York Mason is effective for the repair of recto-urethral fistulas after radical prostatectomy with minor morbidity and no impairment of continence.