Endoscopic vacuum therapy for leaky cavities: is it possible?

Area of Science:

• Urology
• Gastroenterology
• Surgical Innovation

Background:

• Iatrogenic rectal injuries can occur during bladder cancer surgery.
• Recto-urethral fistulas are rare but serious complications, often requiring complex management.
• Previous attempts at conservative management, including percutaneous drainage, were unsuccessful in this case.

Purpose of the Study:

• To describe a minimally invasive, multi-modal endoscopic technique for managing a post-surgical recto-urethral fistula.
• To evaluate the efficacy of endoscopic vacuum therapy (EVT) combined with mechanical closure devices and sealant in treating this complex fistula.

Main Methods:

• A 71-year-old male with a recto-urethral fistula post-Bricker surgery was treated endoscopically.
• Initial treatment involved endoscopic vacuum therapy (EVT) for granulation and cavity reduction.
• Subsequent closure was achieved using over-the-scope clips (OTSC), hemoclips, and biodegradable cyanoacrylate adhesive.

Main Results:

• EVT promoted granulation tissue formation and cavity closure.
• Initial OTSC placement reduced fecaluria but did not achieve complete closure.
• A combination of a second OTSC, hemoclips, and cyanoacrylate adhesive resulted in complete fistula closure and resolution of fecaluria.

Conclusions:

• A multi-modal endoscopic approach integrating EVT, OTSC, hemoclips, and cyanoacrylate adhesive is effective for managing complex recto-urethral fistulas.
• This technique offers a less invasive alternative to traditional surgical repair for selected cases.
• Successful fistula closure was achieved with sustained resolution of symptoms.