Techniques in Coloproctology

, Volume 14, Issue 4, pp 341–343 | Cite as

Treatment of post-prostatectomy rectourethral fistula with fibrin sealant (Quixil™) injection: a novel application

  • V. Verriello
  • M. Altomare
  • G. Masiello
  • C. Curatolo
  • G. Balacco
  • D. F. AltomareEmail author
Technical Note


Rectourethral fistulas in adults is a rare but potentially devastating postoperative condition requiring complex and demanding surgery. Fibrin glue treatment has been used with some success in anal and rectovaginal fistulas, and in the case we present here this indication has been extended to a postoperative rectourethral fistula following radical prostatectomy. For the first time, to our knowledge, a fibrin sealant (Quixil) was injected into the fistula tract, and a rectal mucosal flap was used to close the internal opening. The fistula healed in few weeks, and the patient is symptom free after 1 year of follow-up.


Postoperative rectourethral fistula Fibrin sealant Biological glue 


  1. 1.
    Endo M, Hayashi A, Ishihara M et al (1999) Analysis of 1, 992 patients with anorectal malformations over the past two decades in Japan. Steering Committee of Japanese Study Group of Anorectal Anomalies. J Pediatr Surg 34:435–441CrossRefPubMedGoogle Scholar
  2. 2.
    Vernava AM 3rd, Robbins PL, Brabbee GW (1989) Restorative resection: coloanal anastomosis for benign and malignant disease. Dis Colon Rectum 32:690–693CrossRefPubMedGoogle Scholar
  3. 3.
    Trippitelli A, Barbagli G, Lenzi R, Fiorelli C, Masini GC (1985) Surgical treatment of rectourethral fistulae. Eur Urol 11:388–391PubMedGoogle Scholar
  4. 4.
    Vidal Sans J, Palou Redorta J, Pradell Teigell J, Banus Gassol JM (1985) Management and treatment of eighteen rectourethral fistulas. Eur Urol 11:300–305PubMedGoogle Scholar
  5. 5.
    Nyam DCNK, Pemberton JH (1999) Management of iatrogenic rectourethral fistula. Dis Colon Rectum 42:994–999CrossRefPubMedGoogle Scholar
  6. 6.
    Potenti F, Weiss E, Nessi A et al (1998) Use of nonstimulated gracilis muscle transposition for the treatment of rectovaginal and rectourethral fistulas. Dis Colon Rectum 41:A58Google Scholar
  7. 7.
    Santoro GA, Bucci L, Frizelle FA (1995) Management of rectourethral fistulas in Crohn’s disease. Int J Colorectal Dis 10:183–188CrossRefPubMedGoogle Scholar
  8. 8.
    Joo JS, Weiss EG, Nogueras JJ, Wexner SD (1998) Endorectal advancement flap in perianal Crohn’s disease. Am Surg 64:147–150PubMedGoogle Scholar
  9. 9.
    Abadir R, Ross G Jr, Weinstein SH (1984) Carcinoma of the prostate treated by pelvic node dissection iodine 125 seed implant and external irradiation: a study of rectal complications. Clin Radiol 35:359–361CrossRefPubMedGoogle Scholar
  10. 10.
    Gupta N, Katoch A, Lal P, Hadke NS (2009) Recto urethral fistula after injection sclerotherapy for haemorrhoids, a rare complication. Colorectal Dis [Epub ahead of print]Google Scholar
  11. 11.
    Al-Ali M, Kashmoula D, Saoud IJ (1997) Experience with 30 posttraumatic rectourethral fistulas: presentation of posterior transsphinteric anterior rectal wall advancement. J Urol 158:421–424CrossRefPubMedGoogle Scholar
  12. 12.
    Park JJ, Cintron JR, Orsay CP et al (2000) Repair of chronic anorectal fistulae using commercial fibrin sealant. Arch Surg 135:166–169CrossRefPubMedGoogle Scholar
  13. 13.
    Cintron JR, Park JJ, Orsay CP, Pearl RK, Nelson RL, Abcarian H (1999) Repair of fistulas-in ano using autologous fibrin tissue adhesive. Dis Colon Rectum 42:607–613CrossRefPubMedGoogle Scholar
  14. 14.
    Venkatesh KS, Ramanujam P (1999) Fibrin glue application in the treatment of recurrent anorectal fistulas. Dis Colon Rectum 42:1136–1139CrossRefPubMedGoogle Scholar
  15. 15.
    Patrlj L, Kocman B, Martinac M et al (2000) Fibrin glue-antibiotic mixture in the treatment of anal fistulae: experience with 69 cases. Dig Surg 17:77–80CrossRefPubMedGoogle Scholar
  16. 16.
    Altomare DF, Greco VJ, Tricomi N et al. (2009) Seton or glue for trans-sphincteric anal fistulae. A prospective randomised cross-over clinical trial. Colorectal Dis 13 [Epub ahead of print]Google Scholar
  17. 17.
    Abel ME, Chiu YSY, Russell TR, Volpe PA (1993) Autologous fibrin glue in the treatment of rectovaginal and complex fistulas. Dis Colon Rectum 36:447–449CrossRefPubMedGoogle Scholar
  18. 18.
    Ulrich D, Roos J, Jakse G, Pallua N (2009) Gracilis muscle interposition for the treatment of recto-urethral and rectovaginal fistulas: a retrospective analysis of 35 cases. J Plast Rectonstr Aesthet Surg 62:352–356CrossRefGoogle Scholar
  19. 19.
    Pera M, Alonso S, Parés D et al (2008) Treatment of rectourethral fistula after radical prostatectomy by York Mason posterior trans-sphincteric exposure. Cir Esp 84:323–327CrossRefPubMedGoogle Scholar
  20. 20.
    Nerli R, Amarkhed SS, Hiremath MB (2009) Vascularised tunica vaginalis interposition flap for the treatment of recto-urethral fistulas. Indian J Urol 25:467–469CrossRefPubMedGoogle Scholar
  21. 21.
    Quinlan M, Cahill R, Keane F, Grainger R, Butler M (2005) Transanal endoscopic microsurgical repair of iatrogenic recto-urethral fistula. Surgeon 3:416–417CrossRefPubMedGoogle Scholar
  22. 22.
    Etienney I, Rabahi N, Cuenod CA, Hoffmann P, Charachon A, Bauer P (2009) Fibrin glue sealing in the treatment of a recto-urethral fistula in Crohn’s disease: a case report. Gastroenterol Clin Biol 33:1094–1097CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • V. Verriello
    • 1
  • M. Altomare
    • 1
  • G. Masiello
    • 1
  • C. Curatolo
    • 1
  • G. Balacco
    • 1
  • D. F. Altomare
    • 2
    Email author
  1. 1.Urological DepartmentDon Tonino Bello HospitalMolfettaItaly
  2. 2.Department of Emergency Care and Organ Transplantation, General Surgery and Liver Transplantation UnitsUniversity Aldo MoroBariItaly

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