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Endoscopic Closure of a Large Rectovesical Fistula Following Robotic Prostatectomy.

Andrew Watts1, Neil J Kocher2, Eric Pauli3

  • 1College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA.

Journal of Endourology Case Reports
|October 26, 2020
PubMed
Summary

Rectovesical fistulae (RVF) after prostatectomy are rare but serious. This case demonstrates successful endoscopic closure of a large RVF using a novel multistage technique, avoiding complex open surgery.

Keywords:
endoscopic repairover-the-scope clip systempostoperative complicationprostate cancerprostatectomyrectovesical fistula

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Area of Science:

  • Urology
  • Surgical Innovation
  • Gastroenterology

Background:

  • Rectovesical fistulae (RVF) are uncommon but severe complications following pelvic surgeries.
  • Conventional repair often involves complex reoperative surgery, which may be challenging due to patient comorbidities or adhesions.

Purpose of the Study:

  • To present a unique case of RVF managed with a novel multimodal, multistage endoscopic therapy.
  • To explore endoscopic techniques as a viable alternative to conventional operative repair for RVF.

Main Methods:

  • A patient who developed a large RVF after robotic prostatectomy was treated with a combined cystoscopic and endoscopic approach.
  • The technique involved initial suturing and clipping, followed by three staged endoscopic procedures to gradually reduce fistula size.

Main Results:

  • Complete closure of the rectovesical fistula was achieved through the sequential endoscopic treatments.
  • The patient's colostomy was successfully reversed, restoring bowel continuity.

Conclusions:

  • Multimodal, multistage endoscopic therapy can be an effective alternative for managing rectovesical fistulae, especially in patients with challenging surgical histories.
  • Endoscopic techniques offer a less invasive option for RVF closure when open surgery is impracticable.