Rectourethral fistula following laparoscopic radical prostatectomy

To review the outcome of rectourethral fistula sustained during laparoscopic radical prostatectomy.

A retrospective chart review of all cases managed at a tertiary referral center. Data abstracted included demographics, presenting symptoms, additional interventions, healing, and long-term functional outcome.

Between 2004 and 2009, 10 patients were treated for rectourethral fistula following laparoscopic radical prostatectomy. Mean age was 60 years. Two patients were converted to open prostatectomy for primary repair of the rectal laceration without fecal diversion. The remaining 8 patients (80%) had unrecognized injury at the time of prostatectomy and presented postoperatively. Mean time from radical prostatectomy to presentation with fistula symptoms was 9.5 days. Seven patients (70%) required 1 or more operations to treat or control the symptoms of the rectourethral fistula (median 2.3, mean 2, range 1-4 operations). Three patients (30%) required colostomy within 1 month of radical prostatectomy due to severity of symptoms. Spontaneous healing of the fistula was noted in 6 patients (60%) following diversion (urinary ± fecal diversion), and a minority of patients (30%) required an operation to close the fistula. One patient (10%) required cystectomy for positive margins. During a mean follow-up of 27 months, no recurrent fistula was observed in any of the patients. All patients had normal anal continence, but the majority of patients were incontinent of urine.

Patients who develop a rectourethral fistula following laparoscopic radical prostatectomy often require additional operations for symptoms control and/or healing of the fistula. Urinary continence is affected in the majority of patients.