Conservative treatment for prostatorectal or urethrorectal perforation during transurethral surgical procedures

From 7 March 1989 to 16 December 1989, we experienced 2 prostatorectal and 2 urethrorectal perforations during transurethral surgical procedures at the National Taiwan University Hospital (3 cases) and Tz'u-Chi General Hospital (1 case). All 4 patients were men. Their ages ranged from 57 to 76 years with a mean of 66 years. All 4 complications were identified immediately. Neither a transrectal/suprapubic immediate (or staged) direct suturing, nor a colostomy/cystostomy was needed in our series. Instead, we introduced a rectal tube coated with gauze soaked in Betadine and vaseline, which fit tightly into the rectum for an average of 4 days (range from 3 to 5 days). A 22-Fr three-way indwelling Foley catheter with continuous normal saline irrigation was also applied for 7 to 14 days (9.5 days on average). Nothing by mouth started immediately after the operation (range from 3 to 7 days; 5.3 days on average). All 4 patients were discharged in good condition with a mean postoperative stay of 14 days (range from 11 to 18 days). No prostatorectal or urethrorectal fistula were found during an average follow-up period of 13.5 months (range from 10 to 17 months).