Abstract
Background and Objective:
Rectourethral fistulas (RUFs) can drastically impact a patient’s quality of life. There is no consensus on the management of complex RUFs. However, these are unlikely to resolve with conservative measures alone, often necessitating surgical management that involves a multidisciplinary approach. This video article introduces a novel approach, the first of its kind, for repairing complex RUFs in carefully selected patients who desire to maintain orthotopic urinary and fecal continuity.
Methods and Surgical Procedure:
This video article describes the step-by-step management of a patient with complex RUFs resulting from prior radiation therapy, followed by high-intensity focused ultrasound for prostate cancer. This case was managed with staged reconstruction, combining robotic-assisted transabdominal fistula takedown, Turnbull-Cutait pull-through, and perineal urethral reconstruction.
Key Findings and Limitations:
This combined approach involving robotic and colorectal assistance and transabdominal and perineal techniques may enhance surgical outcomes in selected RUFs. The main limitation remains the technical complexity of the procedure.
Conclusions:
This is the first video article describing a feasible approach for repairing complex RUFs in carefully selected patients who desire to maintain orthotopic urinary and fecal continuity.
Patient Summary:
In this video article, we present the case of a complex rectourethral fistula resulting from multiple procedures to manage prostate cancer, particularly radiation and focal therapy. We conclude that these patients may benefit from the proposed approach as it provides a solution for repairing the fistula, resolving symptoms, and avoiding urinary or fecal diversion.
Author Disclosure Statement:
No competing financial interests exist.
Funding Information:
No funding was received for this article.
Video duration: 7 mins 58 secs.