Outcomes after recto‐anastomosis fistula repair in patients who underwent radical prostatectomy for prostate cancer. (21st November 2013)

• Record Type: Journal Article
• Authors: Pfalzgraf, Daniel; Isbarn, Hendrik; Reiss, Philip; Meyer‐Moldenhauer, Wolf‐Hartmut; Fisch, Margit; Dahlem, Roland
• Is Part Of: BJU international. Volume 113:Number 4(2014:Apr.)
• Page Start: 568
• Page End: 573
• Publication Date: 2013-11-21
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/bju.12254
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju12254-sec-0001" sec-type="section"> <title>Objectives</title> <p> <list id="bju12254-list-0001" list-type="bullet"> <list-item> <p>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).</p> </list-item> <list-item> <p>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.</p> </list-item> </list> </p> </sec> <sec id="bju12254-sec-0002" sec-type="section"> <title>Patients and Methods</title> <p> <list id="bju12254-list-0002" list-type="bullet"> <list-item> <p>A retrospective study of patients treated for recto‐urethral fistulae after RP between 1993 and 2008.</p> </list-item> <list-item> <p>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.</p> </list-item> <list-item> <p>Surgical technique: fistula closure was abdominal in 10 patients, perineal in five and combined abdominal and perineal in two, some with tissue interposition.</p> </list-item> </list> </p> </sec> <sec id="bju12254-sec-0003" sec-type="section"> <title>Results</title> <p> <list id="bju12254-list-0003" list-type="bullet"> <list-item> <p>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.</p> </list-item> <list-item> <p>In two of the 17 patients, rectal injury during the initial surgery was reported; another three had undergone adjuvant radiation therapy (18%).</p> </list-item> <list-item> <p>In 2011, another two patients were deceased; the mean (range) follow‐up was 99.5 (44–184) months.</p> </list-item> <list-item> <p>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.</p> </list-item> </list> </p> </sec> <sec id="bju12254-sec-0004" sec-type="section"> <title>Conclusion</title> <p> <list id="bju12254-list-0004" list-type="bullet"> <list-item> <p>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.</p> </list-item> </list> </p> </sec> </abstract>