Coloanal sleeve anastomosis (Soave procedure): the ultimate treatment option for complex rectourinary fistulas

Acquired rectourinary fistulas represent a therapeutic challenge. Multiple previous unsuccessful procedures increase the difficulty of successful repair, leaving many patients with no option other than permanent urinary and/or fecal diversion. We report our experience with coloanal sleeve anastomosis (Soave procedure) as a salvage procedure for complex rectourinary fistulas.

Between 1994 and 2005, eight males (median age, 60 (range, 33-72) years) had Soave procedure in our institution. Four fistulas were the result of radical prostatectomy and four followed anterior resection for rectal cancer after radiochemotherapy. The location of the fistulas was bladder (n = 5) and urethra (n = 3). Five patients had previous attempts at surgical repair (median, 2 (range, 1-3) operations). The Soave procedure was chosen as first-line treatment because of fistula size (20 mm and 30 mm) in two patients and because of concomitant severe radiation proctitis in one patient.

Morbidity was 38 percent. All patients had a temporary ileostomy, which was successfully reversed in seven patients. One patient required ileal pouch-anal anastomosis on postoperative Day 1 because of necrosis of the descended colon. Two patients had recurrent fistulas at two and three months respectively. One patient had moderate problems with this recurrent fistula and had his stoma closed, but the other patient required a permanent ileostomy.

Soave procedure is an effective treatment for complex rectourinary fistula in the setting of high-dose pelvic radiation or after failed previous repair attempts.