Abstract
Background
Rectovesical fistula is a rare complication following prostatectomy, associated with significant symptoms such as urinary drainage from anus or faecaluria. While several surgical procedures have been described to treat this condition, none of them has been accepted as the universal standard. Transanal endoscopic microsurgery (TEM) is a well-established endoluminal procedure for local excision of rectal tumors. But its application to the repair of rectovesical fistula has been almost unknown.
Methods
We performed TEM as a surgical repair for refractory rectovesical fistula developing after radical prostatectomy in 10 patients. Under the magnified three-dimensional view, through the stereoscope, the fistula and the surrounding rectal mucosa were precisely resected. The defect and the muscle layer of the rectum were closed by hand-sew technique in four layers.
Results
Fistula was completely closed in 7 patients, who eventually underwent enterostomy closure, while in the other 3 patients the fistula recurred. In the three recurrent cases, the fistula was associated with wide, tough scar tissue due to previous irradiation, HIFU, or repeated surgical repair attempts.
Conclusions
Rectovesical fistulas associated with wide, tough scar tissue due to multi-time attempt of surgical repair or any type of energy ablation should not be indicated for repair by TEM. However, for simple fistulas without tough, fibrotic surroundings, TEM can be indicated as a minimally invasive surgical option with very low morbidity, without any incision in healthy tissue for approach.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Thomas C, Jones J, Jäger W, Hampel C, Thüroff JW, Gillitzer RJ (2009) Incidence, clinical symptoms and management of rectourethral fistulas after radical prostatectomy. J Urol 183:608–612
Buckley JC (2011) Complications after radical prostatectomy: anastomotic stricture and rectourethral fistula. Curr Opin Urol 21:461–464
Buess G, Kipfmüller K, Hack D, Grüssner R, Heintz A, Junginger T (1988) Technique of transanal endoscopic microsurgery. Surg Endosc 2:71–75
Lirici MM, Kanehira E, Melzer A, Schurr MO (2014) The outburst age: how TEM ignited the MIS revolution. Minim Invasive Ther Allied Technol 23:1–4
Zmora O, Tulchinsky H, Gur E, Goldman G, Klausner JM, Rabau M (2006) Gracilis muscle transposition for fistulas between the rectum and urethra or vagina. Dis Colon Rectum 49:1316–1321
Zmora O, Potenti FM, Wexner SD, Pikarsky AJ, Efron JE, Nogueras JJ, Pricolo VE, Weiss EG (2003) Gracilis muscle transposition for iatrogenic rectourethral fistula. Ann Surg 237:483–487
Voelzke BB, McAninch JW, Breyer BN, Glass AS, Garcia-Aguilar J (2013) Transperineal management for postoperative and radiation rectourethral fistulas. J Urol 189:966–971
Hechenbleikner EM, Buckley JC, Wick EC (2013) Acquired rectourethral fistulas in adults: a systematic review of surgical repair techniques and outcomes. Dis Colon Rectum 56:374–383
Renschler TD, Middleton RG (2003) 30 years of experience with York-Mason repair of recto-urinary fistulas. J Urol 170:1222–1225
Hadley DA, Southwick A, Middleton RG (2012) York-Mason procedure for repair of recto-urinary fistulae: a 40-year experience. BJU Int 109:1095–1098
Wilbert DM, Buess G, Bichler KH (1996) Combined endoscopic closure of rectourethral fistula. J Urol 155:256–258
Kanehira E, Tanida T, Kamei A, Nakagi M, Hideshima A (2014) A single surgeon’s experience with transanal endoscopic microsurgery over 20 years with 153 early cancer cases. Minim Invasive Ther Allied Technol 23:5–9
Arezzo A, Arolfo S, Cravero F, Migliore M, Allaix ME, Morino M (2014) Which treatment for large rectal adenoma? Preoperative assessment and therapeutic strategy. Minim Invasive Ther Allied Technol 23:21–27
Nfonsam VN, Mateka JJ, Prather AD, Marcet JE (2013) Short-term outcomes of the surgical management of acquired rectourethral fistulas: does technique matter? Res Rep Urol 30:47–51
Schurr MO, Arezzo A, Ho CN, Anhoeck G, Buess G, Di Lorenzo N (2008) The OTSC clip for endoscopic organ closure in NOTES: device and technique. Minim Invasive Ther Allied Technol 17:262–266
Weiland T, Fehlker M, Gottwald T, Schurr MO (2012) Performance of the OTSC System in the endoscopic closure of gastrointestinal fistulae–a meta-analysis. Minim Invasive Ther Allied Technol 21:249–258
Mangiavillano B, Pisani A, Viaggi P, Arena M, Opocher E, Mangano M, Santoro T, Masci E (2010) Endoscopic sealing of a rectovesical fistula with a combination of an over the scope clip and cyano-acrylate injection. J Gastrointest Oncol 1:122–124
Mori H, Kobara H, Fujihara S, Nishiyama N, Kobayashi M, Masaki T, Izuishi K, Suzuki Y (2012) Rectal perforations and fistulae secondary to a glycerin enema: closure by over-the-scope-clip. World J Gastroenterol 28:3177–3180
Disclosures
Eiji Kanehira, Takashi Tanida, Aya Kamei, Masafumi Nakagi, Mitsuharu Iwasaki, and Hirofumi Shimizu have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kanehira, E., Tanida, T., Kamei, A. et al. Transanal endoscopic microsurgery for surgical repair of rectovesical fistula following radical prostatectomy. Surg Endosc 29, 851–855 (2015). https://doi.org/10.1007/s00464-014-3737-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-014-3737-x