AIM: Most patients presenting with rectourethral fistula acquire it as a complication of radiotherapy for prostate cancer or by injury to the rectum during prostatectomy, trauma or from Crohn's disease.
This study examined whether choice of operation and results of surgery for rectourethral fistula are influenced by prior radiotherapy.
METHOD: Male patients undergoing surgery for rectourethral fistula were identified from a prospectively maintained database. Data regarding etiology, surgical treatment and outcomes were analyzed.
RESULTS: Fifty patients were identified (median age 65.5 years). Radiation was received by 29 patients for prostate or rectal cancer and 21 patients developed a fistula following prostatectomy, Crohn's disease or pelvic fracture (without radiation). Prior to definitive surgery, 30 patients underwent fecal and 37 urinary diversion. A total of 57 repairs were performed (44 patients had one, 5 two and one 3 repairs). Definitive surgery was approached predominantly abdominally in radiated (90.6% vs. 9.3%, p< 0.001) and perineally in non-radiated patients (80% vs. 20%, p< 0.001). Successful primary fistula repair was more frequent in non-radiated group vs. radiated groups (80.9% vs. 0%, p< 0.001). Permanent colostomy and urinary diversion was more often required in radiated vs. non-radiated patients (colostomy 83% vs. 0%, p< 0.001, urorostomy 100% vs. 19%, p< 0.001).
CONCLUSION: Few patients with radiation-induced rectourethral fistula avoid permanent colostomy and urostomy. In contrast, most patients with non radiation-related fistulas undergo successful perineal repair without permanent faecal and urinary diversion.
Written by:
Beddy D, Poskus T, Umbreit E, Larson DW, Elliott DS, Dozois EJ. Are you the author?
Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, 200 First Street SW, Rochester, MN, 55905, USA.
Reference: Colorectal Dis. 2013 Jul 11. Epub ahead of print.
doi: 10.1111/codi.12350
PubMed Abstract
PMID: 23841640
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