Evaluation of the Approach to Rectal Injuries During Pelvic Uro-Oncological Surgery

Background/Objectives: Rectal injuries are rare but serious complications during pelvic surgeries. This study aimed to share our experience with primary repair of rectal injuries occurring during pelvic uro-oncological surgeries. Methods: A total of 494 patients who presented to our clinic with diagnoses of non-metastatic bladder tumors and prostate cancer and underwent radical prostatectomy, and 214 patients who underwent radical cystectomy between 2010 and 2024 were included in the study. Data from 15 patients who experienced rectal injury during pelvic uro-oncological surgery were retrospectively reviewed. Patients scheduled for radical prostatectomy received rectal enemas twice a day (morning and evening) the day before surgery. Patients scheduled for radical cystectomy received a liquid diet for three days preoperatively, along with rectal enemas morning and evening. Results: Rectal injury occurred in 7 (1.4%) patients during radical prostatectomy and in 8 (3.7%) patients during radical cystectomy. All rectal injuries were detected intraoperatively. The defect was closed in two layers: muscular and serosal. Patients had no active complaints during follow-up, and no rectourinary fistula was observed. Conclusions: Intraoperative detection of rectal injury during pelvic uro-oncological surgery and high-quality primary repair of the defect play a critical role in preventing morbidity and mortality associated with rectal injury. Preoperative mechanical bowel preparation reduces contamination of the procedure, improves the visibility of the defect, and allows for high-quality primary repair.