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Keywords:

  • fistula;
  • prostate cancer;
  • urorectal fistula repair;
  • reconstruction

Objectives

  • To assess fistula recurrence rate and health-related quality of life (HRQL) after repair, as well as the impact on continence and erection in patients with recto-anastomotic fistula after radical prostatectomy (RP).
  • In recent publications, the numbers of cases of recto-urinary fistulae after RP are relatively small. Success rates at fistula closure are good; however, data about functional outcomes and HRQL are more restricted.

Patients and Methods

  • A retrospective study of patients treated for recto-urethral fistulae after RP between 1993 and 2008.
  • All 17 patients were assessed for fistula recurrence in 2007 and received a standardised non-validated questionnaire to assess HRQL in 2011; furthermore, a patient's chart review was performed.
  • Surgical technique: fistula closure was abdominal in 10 patients, perineal in five and combined abdominal and perineal in two, some with tissue interposition.

Results

  • In 2007, follow-up was available for 14 patients, one was deceased and two were lost to follow-up. The mean follow-up was 73.3 months and the mean patient age was 63 years.
  • In two of the 17 patients, rectal injury during the initial surgery was reported; another three had undergone adjuvant radiation therapy (18%).
  • In 2011, another two patients were deceased; the mean (range) follow-up was 99.5 (44–184) months.
  • There was a great improvement in HRQL as compared with before surgery in seven of the 12 evaluable patients, a slight improvement in one and no change in three. In all, eight of the 12 patients were very satisfied with the surgery and four were satisfied.

Conclusion

  • Perineal or abdominal fistula repair yields excellent success rates and high patient satisfaction. However, urinary incontinence can be found in some patients postoperatively, requiring further treatment.