Skip to main content
SpringerLink
Log in

Robotic Approach for Rectourethral Fistula

  • Chapter
  • First Online:
Urinary Fistula

  • 266 Accesses

Abstract

Rectourethral fistula (RUF) is an epithelized connection between the epithelium of the rectum and the urethra. Historically, this infrequent but bothersome pathology occurred after interventions for benign prostatic pathologies. Nowadays, RUF are more commonly a consequence of energy treatments for prostate cancer (PCa) and neoadjuvant chemoradiation for colorectal malignancies. RUF are associated with recurrent urinary tract infections that can lead to kidney injury, sepsis, and death. This chapter aims to review the general aspects of RUF and describe the robotic surgical repair to give clinicians a better insight of this pathology and the technical aspects of the repair.

Financial disclaimer/Conflict of interest: Authors do not have any financial disclaimer or conflict of interest to declare.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

BPH:

Benign prostatic hyperplasia

ICG:

Indocynanine green

PCa:

Prostate cancer

RP:

Radical prostatectomy

RUF:

Rectourethral fistula

RVF:

Rectovesical fistula

VUA:

Vesicourethral anastomosis

References

  1. Núñez Bragayrac LA, Azhar RA, Sotelo R. Minimally invasive management of urological fistulas. Curr Opin Urol. 2015;25(2):136–42. https://doi.org/10.1097/MOU.0000000000000144.

    Article  Google Scholar 

  2. Núñez Bragayrac LA, Hatcher DM, Sotelo RJ. Urinary fistulas. In: Sotelo RAM, Arriaga J, editors. Complications in robotic urologic surgery. Cham: Springer; 2018. p. 285–97.

    Chapter  Google Scholar 

  3. Nfonsam VN, Mateka JJ, Prather AD, Marcet JE. Short-term outcomes of the surgical management of acquired rectourethral fistulas: does technique matter? Res Rep Urol. 2013;5:47–51. https://doi.org/10.2147/RRU.S28002.

    Article  Google Scholar 

  4. Hechenbleikner EM, Buckley JC, Wick EC. Acquired rectourethral fistulas in adults: a systematic review of surgical repair techniques and outcomes. Dis Colon Rectum. 2013;56(3):374–83. https://doi.org/10.1097/DCR.0b013e318274dc87.

    Article  Google Scholar 

  5. Lane BR, Stein DE, Remzi FH, Strong SA, Fazio VW, Angermeier KW. Management of radiotherapy induced rectourethral fistula. J Urol. 2006;175(4):1382–7; discussion 7-8

    Article  Google Scholar 

  6. Ramírez-Martín D, Jara-Rascón J, Renedo-Villar T, Hernández-Fernández C, Lledó-García E. Rectourethral fistula management. Curr Urol Rep. 2016;17(3):22. https://doi.org/10.1007/s11934-016-0578-2.

    Article  Google Scholar 

  7. Chrouser KL, Leibovich BC, Sweat SD, et al. Urinary fistulas following external radiation or permanent brachytherapy for the treatment of prostate cancer. J Urol. 2005;173(6):1953–7. https://doi.org/10.1097/01.ju.0000158041.77063.ff.

    Article  Google Scholar 

  8. Thomas C, Jones J, Jäger W, Hampel C, Thüroff JW, Gillitzer R. Incidence, clinical symptoms and management of rectourethral fistulas after radical prostatectomy. J Urol. 2010;183(2):608–12. https://doi.org/10.1016/j.juro.2009.10.020.

    Article  Google Scholar 

  9. Medina LG, Cacciamani GE, Hernandez A, et al. Robotic management of rectourethral fistulas after focal treatment for prostate cancer. Urology. 2018;118:241. https://doi.org/10.1016/j.urology.2018.05.012.

    Article  Google Scholar 

  10. Chetty R, McCarthy AJ. Neoadjuvant chemoradiation and rectal cancer. J Clin Pathol. 2019;72(2):97–101. https://doi.org/10.1136/jclinpath-2018-205592.

    Article  Google Scholar 

  11. Long JP, Bahn D, Lee F, Shinohara K, Chinn DO, Macaluso JN Jr. Five-year retrospective, multi-institutional pooled analysis of cancer-related outcomes after cryosurgical ablation of the prostate. Urology. 2001;57(3):518–23.

    Article  CAS  Google Scholar 

  12. Acher PL, Hodgson DJ, Murphy DG, Cahill DJ. High-intensity focused ultrasound for treating prostate cancer. BJU Int. 2007;99(1):28–32. https://doi.org/10.1111/j.1464-410X.2006.06523.x.

    Article  CAS  Google Scholar 

  13. Pisansky TM, Kozelsky TF, Myers RP, et al. Radiotherapy for isolated serum prostate specific antigen elevation after prostatectomy for prostate cancer. J Urol. 2000;163(3):845–50.

    Article  CAS  Google Scholar 

  14. Bosset JF, Calais G, Mineur L, et al. Enhanced tumorocidal effect of chemotherapy with preoperative radiotherapy for rectal cancer: preliminary results--EORTC 22921. J Clin Oncol. 2005;23(24):5620–7. https://doi.org/10.1200/JCO.2005.02.113.

    Article  CAS  Google Scholar 

  15. McLaren RH, Barrett DM, Zincke H. Rectal injury occurring at radical retropubic prostatectomy for prostate cancer: etiology and treatment. Urology. 1993;42(4):401–5. https://doi.org/10.1016/0090-4295(93)90366-i.

    Article  CAS  Google Scholar 

  16. Peeters KC, Marijnen CA, Nagtegaal ID, Kranenbarg EK, Putter H, Wiggers T, et al. The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg. 2007;246(5):693–701.

    Article  Google Scholar 

  17. Medina LG, Rangel E, Fuchs I, Silva MC, Hernandez A, Cacciamani GE, Sotelo R. Rectourethral fistula: operative technique and outcomes. Curr Bladder Dysfunct Rep. 2019. https://doi.org/10.1007/s11884-019-00529-4.

  18. Singla N, Morey AF. Rectourethral fistula reconstruction in elderly patients. Curr Opin Urol. 2016;26(2):171–6. https://doi.org/10.1097/MOU.0000000000000263.

    Article  Google Scholar 

  19. Noldus J, Fernandez S, Huland H. Rectourinary fistula repair using the Latzko technique. J Urol. 1999;161(5):1518–20.

    Article  CAS  Google Scholar 

  20. Sotelo R, Mirandolino M, Trujillo G, et al. Laparoscopic repair of rectourethral fistulas after prostate surgery. Urology. 2007;70(3):515–8. https://doi.org/10.1016/j.urology.2007.04.029.

    Article  Google Scholar 

  21. Venkatesan K, Zacharakis E, Andrich DE, Mundy AR. Conservative management of urorectal fistulae. Urology. 2013;81(6):1352–6. https://doi.org/10.1016/j.urology.2012.10.040.

    Article  Google Scholar 

  22. Nyam DC, Pemberton JH. Management of iatrogenic rectourethral fistula. Dis Colon Rectum. 1999;42(8):994–9. https://doi.org/10.1007/BF02236689.

    Article  CAS  Google Scholar 

  23. Lightner DJ, Wymer K, Sanchez J, Kavoussi L. Best practice statement on urologic procedures and antimicrobial prophylaxis. J Urol. 2020;203(2):351–6. https://doi.org/10.1097/JU.0000000000000509.

    Article  Google Scholar 

  24. Hasson HM. A modified instrument and method for laparoscopy. Am J Obstet Gynecol. 1971;110(6):886–7. https://doi.org/10.1016/0002-9378(71)90593-x.

    Article  CAS  Google Scholar 

  25. Paparel P, Caillot JL, Perrin P, Ruffion A. Surgical principles of omentoplasty in urology. BJU Int. 2007;99(5):1191–6. https://doi.org/10.1111/j.1464-410X.2007.06869.x.

    Article  Google Scholar 

  26. Kim TD, Gantt G Jr, Kochar K, Marecik S, Park JJ. Rectourethral fistula repair with endorectal advancement flap and implantation of biologic mesh. Dis Colon Rectum. 2021;64(1):e1. https://doi.org/10.1097/DCR.0000000000001827.

    Article  Google Scholar 

  27. Zuin M, Ruperto M, Balduino M, et al. Rectal advancement flap plus adipose lipofilling (RAFAL) for the treatment of rectourethral fistulas after radical prostatectomy. Tech Coloproctol. 2019;23(10):1003–7. https://doi.org/10.1007/s10151-019-02078-8.

    Article  CAS  Google Scholar 

  28. Reynolds WS, Gottlieb LJ, Lucioni A, Rapp DE, Song DH, Bales GT. Vesicovaginal fistula repair with rectus abdominus myofascial interposition flap. Urology. 2008;71(6):1119–23. https://doi.org/10.1016/j.urology.2007.12.057.

    Article  Google Scholar 

  29. Guillonneau B, Vallancien G. Laparoscopic radical prostatectomy: Initial experience and preliminary assessment after 65 operations. Prostate. 1999;39:71–5.

    Article  CAS  Google Scholar 

  30. Shah M, Medina LG, Azhar RA, et al. Urine leak after robotic radical prostatectomy: not all urine leaks come from the anastomosis. J Robot Surg. 2022;16(2):247–55. https://doi.org/10.1007/s11701-021-01242-3.

    Article  Google Scholar 

  31. Van Velthoven RF, Ahlering TE, Peltier A, Skarecky DW, Clayman RV. Technique for laparoscopic running urethrovesical anastomosis: the single knot method. Urology. 2003;61(4):699–702. https://doi.org/10.1016/s0090-4295(02)02543-8.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Anibal La Riva, Luis G. Medina & René Sotelo

Authors
  1. Anibal La Riva
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Luis G. Medina
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. René Sotelo
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA

    René Sotelo

  2. Capital Health – Urology Specialists, Capital Health Medical Center, Pennington, NJ, USA

    Charles F. Polotti

  3. School of Medicine and Health Sciences, Universidad de Sonora, Hermosillo, Mexico

    Juan Arriaga

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

La Riva, A., Medina, L.G., Sotelo, R. (2022). Robotic Approach for Rectourethral Fistula. In: Sotelo, R., Polotti, C.F., Arriaga, J. (eds) Urinary Fistula. Springer, Cham. https://doi.org/10.1007/978-3-031-15317-4_20

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-15317-4_20

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-15316-7

  • Online ISBN: 978-3-031-15317-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation