To assess the role of TEO/TEM in recto-urethral fistulas (RUF). RUF may appear after radical prostatectomy. Their treatment represents a challenge; many therapies have been proposed, from conservative to aggressive surgical approaches. Transanal endoscopic surgery (TEO/TEM) is a minimally invasive technique to access the site of the RUF to perform repair.
Observational study with prospective data collection, conducted between September 2006 and December 2015. All patients were diagnosed with RUF following management of prostate cancer. Conservative treatment was administered in the form of urinary and fecal diversion with cystotomy and terminal colostomy, to achieve total urinary and fecal exclusion. If the fistula persisted it was treated by TEO/TEM, with or without biological mesh interposition. If this failed, gracilis muscle was applied as salvage therapy.
Ten patients were diagnosed with RUF. In one patient (1/10) the fistula healed with bladder catheterization alone. In another patient (1/9), it resolved after total urinary and fecal exclusion. Eight patients underwent repair by TEO/TEM, four with biological mesh interposition; all four presented recurrence. In the other four patients treated via TEO/TEM, two had early recurrence, while the others had healed at follow-up visits after 4-6 months (2/8) - success rate of 25%. The six patients who recurred were treated with gracilis muscle interposition via a transperineal approach.
The low rate of positive results obtained by TEO/TEM argues against its use as technique of choice in RUF, and against the use of biological meshes.
Urology. 2017 Sep 12 [Epub ahead of print]
X Serra-Aracil, M Labro-Ciurans, L Mora-Lopez, J Muñoz-Rodriguez, R Martos-Calvo, J Prats-López, S Navarro-Soto
Coloproctology Unit. General and Digestive Surgery Service., Coloproctology Unit. General and Digestive Surgery Service. Electronic address: ., Urology Service. Parc Taulí University Hospital. Universidad Autònoma de Barcelona. Sabadell (Barcelona). Spain.