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Outcomes of gracilis muscle interposition for rectourethral fistulas caused by treatment of prostate cancer

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Abstract

Background

Gracilis muscle interposition (GMI) has been associated with favorable outcomes in treating complex perianal fistulas. Outcomes of GMI may vary according to the fistula etiology, particularly between rectovaginal fistulas in women and rectourethral fistulas (RUF) in men. The aim of this study was to assess the outcome of GMI to treat RUF acquired after prostate cancer treatment.

Methods

This retrospective cohort study included male patients treated with GMI for RUF acquired after prostate cancer treatment between January 2000 and December 2018 in the Department of Colorectal Surgery, Cleveland Clinic Florida. The primary outcome was the success of GMI, defined as complete healing of RUF without recurrence. Secondary outcomes were length of hospital stay and postoperative complications.

Results

This study included 53 male patients with a median age of 68 (range, 46–85) years. Patients developed RUF after treatment of prostate cancer with radiation (52.8%), surgery (34%), or transurethral resection of the prostate (TURP) (13.2%). Median hospital stay was 5 (IQR, 4–7) days. Twenty (37.7%) patients experienced 25 complications, the most common being wound infection and dehiscence. Primary healing after GMI was achieved in 28 (52.8%) patients. Fifteen additional patients experienced successful healing of RUF after additional procedures, for a total success rate of 81.1%. Median time to complete healing was 8 (range, 4–56) weeks. The only significant factor associated with outcome of GMI was wound dehiscence (p = 0.008).

Conclusions

Although the initial success rate of GMI was approximately 53%, it increased to 81% after additional procedures. Complications after GMI were mostly minor, with wound complications being the most common. Perianal wound dehiscence was significantly associated with failure of healing of RUF after GMI.

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Authors and Affiliations

  1. Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA

    S. H. Emile, N. Horesh, V. Strassmann, Z. Garoufalia, R. Gefen, P. Zhou, E. Ray-Offor, G. Dasilva & S. D. Wexner

  2. Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt

    S. H. Emile

  3. Department of Surgery and Transplantation, Sheba Medical Center, Ramat-Gan, Israel

    N. Horesh

  4. Faculty of Medicine, Hadassah Medical Organization, Hebrew University of Jerusalem, Jerusalem, Israel

    R. Gefen

  5. Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33179, USA

    S. D. Wexner

Authors
  1. S. H. Emile
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  2. N. Horesh
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  3. V. Strassmann
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  4. Z. Garoufalia
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  5. R. Gefen
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  6. P. Zhou
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  7. E. Ray-Offor
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  8. G. Dasilva
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  9. S. D. Wexner
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Corresponding author

Correspondence to S. D. Wexner.

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Conflict of interest

Dr. Wexner reports receiving consulting fees from ICON Language Services, IntuitiveSurgical, Stryker, Medtronic, Takeda, ARC/Corvus, Astellas, Baxter, Olympus, Livsmed, GI Supply, and Leading BioSciences and receiving royalties from Medtronic, Intuitive Surgical, Karl Storz Endoscopy America Inc, and Unique Surgical Innovations, LLC.

Ethical Approval

Data used in the study were derived from an IRB-approved (FLA 14-039) database of the Department of Colorectal Surgery, Cleveland Clinic Florida.

Informed Consent

Informed consent to particpate in the study was waived due to the retrospective nature of the study.

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Emile, S.H., Horesh, N., Strassmann, V. et al. Outcomes of gracilis muscle interposition for rectourethral fistulas caused by treatment of prostate cancer. Tech Coloproctol 27, 937–944 (2023). https://doi.org/10.1007/s10151-023-02759-5

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  • DOI: https://doi.org/10.1007/s10151-023-02759-5

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