Outcomes after recto-anastomosis fistula repair in patients who underwent radical prostatectomy for prostate cancer
Article first published online: 21 NOV 2013
© 2013 The Authors. BJU International © 2013 BJU International
Volume 113, Issue 4, pages 568–573, April 2014
How to Cite
Pfalzgraf, D., Isbarn, H., Reiss, P., Meyer-Moldenhauer, W.-H., Fisch, M. and Dahlem, R. (2014), Outcomes after recto-anastomosis fistula repair in patients who underwent radical prostatectomy for prostate cancer. BJU International, 113: 568–573. doi: 10.1111/bju.12254
- Issue published online: 14 MAR 2014
- Article first published online: 21 NOV 2013
- Accepted manuscript online: 23 MAY 2013 06:48AM EST
- prostate cancer;
- urorectal fistula repair;
- 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.
- 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.
- 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.