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Rectal advancement flap plus adipose lipofilling (RAFAL) for the treatment of rectourethral fistulas after radical prostatectomy

  • Technical Note
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Abstract

Background

Rectourethral fistula (RUF) is a rare but significant complication after radical prostatectomy. Many different approaches have been used, but none of them has become the standard of care.

Methods

We present our series of seven patients treated with a transanal rectal advancement flap plus the injection of mesenchymal stem cells, to facilitate the healing of the fistula. Mesenchymal cells were obtained by a new mechanical device known as LIPOGEMS®. We called this technique RAFAL (rectal advancement flap plus adipose lipofilling). In all patients the RUF was a complication of laparoscopic radical prostatectomy. Fistula size ranged from 0.3 to 0.5 cm (median 0.4 cm).

Results

After a median follow-up of 53 months (range 6–163 months), 2 out of 7 patients experienced RUF recurrence. In both cases recurrence was successfully treated by the York-Mason technique in one case and by redo RAFAL in the other. Success rate of RAFAL was 71% (5 of 7). The total success rate of primary RAFAL and redo- RAFAL was 85.7% (6 of 7). No short- or long-term complications were seen.

Conclusions

In our patient population this new procedure was safe and effective.

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Author information

Authors and Affiliations

  1. Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università degli Studi di Padova, Clinica Chirurgica 1, Via Giustiniani 2, Padova, 35128, Italy

    M. Zuin

  2. U.O.C. Chirurgia Generale, Ospedale San Giacomo – ULSS 2, Castelfranco Veneto, Italy

    M. Ruperto & M. Balduino

  3. IOV I.R.C.C.S, U.O.C. Urologia, Castelfranco Veneto, Italy

    A. Amodeo & L. De Zorzi

  4. Division of Visceral Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland

    B. Roche

  5. Ospedale di Conegliano Veneto - ULSS 2, U.O.C. Chirurgia Generale, Conegliano, Italy

    M. Pavanello & C. Sernagiotto

  6. Clinica Chirurgica I, Azienda Ospedaliera di Padovavia Giustiniani, 35128, Padua, Italy

    M. Zuin

Authors
  1. M. Zuin
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  2. M. Ruperto
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  3. M. Balduino
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  4. A. Amodeo
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  5. L. De Zorzi
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  6. B. Roche
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  7. M. Pavanello
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  8. C. Sernagiotto
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Contributions

Conception and design: SC, RM, ZM, AA. Acquisition, analysis, or interpretation of data: ZM, SC, AA, BM, RM. Draft of the manuscript: ZM. Critical revision of the manuscript: SC, ZM. Final approval of the version to be published: ZM, RM, AA, DZ, BM, PM, RB, SC. All the authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to M. Zuin.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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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 23, 1003–1007 (2019). https://doi.org/10.1007/s10151-019-02078-8

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  • DOI: https://doi.org/10.1007/s10151-019-02078-8

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