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Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Considerations before repair of acquired rectourethral and urethrovaginal fistulas in children
Guo-Chang Liu1, Hui-Min Xia, Ying-Quan Wen
1Department of Pediatric Surgery, Guangzhou Children's Hospital, Guangzhou 510120, China. liuguochang2004@yahoo.com.cn
Insights
Repairing rectourethral and urethrovaginal fistulas is best done at least six months after the last procedure. The one-stage York-Mason procedure offers a feasible and effective surgical solution for these complex conditions.
Area of Science:
- Pediatric surgery
- Urology
- Gastroenterology
Background:
- Acquired rectourethral or urethrovaginal fistulas are rare complications of pelvic disorders.
- Causes include trauma, iatrogenic injury, inflammatory bowel disease, neoplasms, and infections.
- Optimal timing and surgical methods for fistula repair lack consensus.
Purpose of the Study:
- To determine the appropriate timing for surgical repair of rectourethral and urethrovaginal fistulas.
- To evaluate the effectiveness of the York-Mason procedure for fistula repair.
Main Methods:
- Nineteen children (15 boys, 4 girls) with rectourethral or urethrovaginal fistulas were treated between 1998 and 2006.
- Fistulas resulted from pelvic fractures (10) or iatrogenic injury (9).
- A one-stage York-Mason procedure was performed at least 6 months post-injury, with complete excision of the fistulous tract.
Main Results:
- All 19 fistulas were successfully closed.
- No patients experienced fecal or urinary incontinence post-repair.
- Minor complications included infection (2) and wound dehiscence (2); scars were excised to prevent urethral stricture.
Conclusions:
- Surgical repair of acquired rectourethral or urethrovaginal fistulas is recommended at least 6 months after the inciting event.
- The one-stage York-Mason procedure is a feasible and effective surgical approach for these pediatric fistulas.
Background:
Acquired rectourethral or urethrovaginal fistula between the rectum or vaginal and lower urinary tract is an uncommon entity, which occurs as a consequence of pelvic disorder, including trauma, iatrogenic injury, inflammatory bowel disease, pelvic neoplasm or infection. But when is it appropriate to repair the fistula and what methods to be chosen? There has been no consensus on them. This study was undertaken to determine the timing of the procedure and the repair of rectourethral and urethrovaginal fistula.
Methods:
From 1998 to 2006, we treated 19 children with rectourethral or urethrovaginal fistula, including rectourethral fistula in 15 boys and urethrovaginal fistula in 4 girls. The mean age of the patients was 6.2 years (range, 8 months to 11.5 years). The fistula occurred after pelvic fracture in 10 patients, and after iatrogenic injury in 9 including 4 after radical operation for Hirschsprung's disease and 5 due to anorectal malformation. Preoperatively, the general and local infections were controlled thoroughly, and complications such as urethral stricture and secondary megacolon were treated at first. At least 6 months after the last procedure, all patients underwent the 1-stage York-Mason procedure (via parasacrococcygeal incision) without colostomy and suprapubic cystostomy. Intraoperatively, the entire fistulous tract was excised completely.
Results:
Infection and partial dehiscence of the wound occurred in 2 patients respectively. All fistulae were closed successfully without fecal incontinence or postoperative anal stricture. No patient suffered from urinary incontinence after fistula repair. The scars around the fistula were removed because they would shrink and lead to subsequent urethral occlusion or stricture.
Conclusions:
The timing of operation for acquired rectourethral or urethrovaginal fistula is appropriate at least 6 months after the last procedure. The 1-stage York-Mason procedure for the repair of the fistula is feasible and effective.
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