Repair of a rectovesical fistula following laparoscopic radical prostatectomy with Martius fat pad flap interposition: a proposal of a new technique

Abstract

Rectovesical fistula (RVF) is defined as an abnormal communication between the rectum and the urinary bladder, most commonly after an iatrogenic injury during pelvic surgery. Patients with RVF may have various clinical presentations, ranging from fecaluria, pneumaturia, to urine leakage through the anus. The quality of life for patients with this pathology is adversely affected owing to the associated psychological burden. Surgery is the preferred treatment given the low success rates reported for conservative or minimally invasive approaches. Herein, we present a case of a 65-year-old man with RVF after radical prostatectomy successfully treated by a transperineal approach using a modified Martius procedure.

Figure 1. a, b

Axial plane (a) and sagittal reconstruction (b) of the CT scan performed by the injection of the contrast through a bladder catheter showing the location of the fistula CT: computed tomography

Figure 2. a–f

The Martius fat pad flap procedure for rectovesical fistula repair: (a) an inverted Y-shaped incision is performed along the median perineal raphe, then, crossed the anal sphincter, and the bladder side of the fistula is identified, and the catheter is visualized (blue arrow); (b) rectal tract defect identification (blue arrow), circumscription, and dissection is performed; (c) bladder and rectum defects (blue arrows) are closed separately following a perpendicular line, using interrupted sutures with 3-0 monofilament; (d and e) a flap of adipose tissue (red arrow) from the interspace between the bulbocavernosus/bulbospongiosus and ischiocavernosus is isolated and prepared; (f) Flap interposition between the bladder and rectum wall is accomplished (red arrow)