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Rectourethral fistula following laparoscopic radical prostatectomy
1Department of Surgery, Kaiser Permanente, 4760 Sunset Boulevard, Los Angeles, CA 90027, USA.
Techniques in Coloproctology
|July 2, 2011
Summary
Rectourethral fistula after laparoscopic radical prostatectomy often requires multiple surgeries for management. While anal continence is preserved, most patients experience urinary incontinence post-treatment.
Area of Science:
- Urology
- Surgical Oncology
- Gastroenterology
Background:
- Laparoscopic radical prostatectomy (LRP) is a common treatment for prostate cancer.
- Rectourethral fistula (RUF) is a rare but serious complication following LRP.
- Understanding the outcomes of RUF management is crucial for patient care.
Purpose of the Study:
- To review the outcomes of patients who developed rectourethral fistula after LRP.
- To analyze the interventions, healing rates, and functional outcomes in these patients.
Main Methods:
- Retrospective chart review of 10 patients treated for RUF post-LRP at a tertiary referral center (2004-2009).
- Data collected included demographics, symptoms, interventions, healing status, and long-term functional outcomes.
- Analysis focused on surgical management, healing rates, and continence.
Main Results:
- Eight of 10 patients (80%) presented postoperatively with unrecognized RUF, with a mean symptom onset of 9.5 days after LRP.
- Seventy percent of patients required one or more additional operations for RUF management; 30% needed colostomy.
- Sixty percent achieved spontaneous fistula healing after diversion, while 30% required surgical closure. Most patients retained anal continence but experienced urinary incontinence.
Conclusions:
- Rectourethral fistula following LRP frequently necessitates further surgical interventions for symptom control and healing.
- Urinary continence is significantly impacted in the majority of patients who develop RUF post-LRP.
- Long-term follow-up showed no fistula recurrence in this cohort.
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