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Rectourethral Fistula: Systemic Review of and Experiences With Various Surgical Treatment Methods

대한대장항문학회지 2014년 30권 1호 p.35 ~ 41


 ( Choi Ji-Hye ) - Seoul National University College of Medicine Department of Surgery
 ( Jeon Byeong-Geon ) - Bundang Jesaeng Hospital Department of Surgery
 ( Choi Sang-Gi ) - Seoul National University College of Medicine Department of Surgery
 ( Han Eon-Chul ) - Seoul National University College of Medicine Department of Surgery
 ( Ha Heon-Kyun ) - Seoul National University College of Medicine Department of Surgery
 ( Oh Heung-Kwon ) - Seoul National University College of Medicine Department of Surgery
 ( Choe Eun-Kyung ) - Seoul National University College of Medicine Department of Surgery
 ( Moon Sang-Hui ) - Seoul National University College of Medicine Department of Surgery
 ( Ryoo Seung-Bum ) - Seoul National University College of Medicine Department of Surgery
 ( Park Kyu-Joo ) - Seoul National University College of Medicine Department of Surgery

Abstract


Purpose: A rectourethral fistula (RUF) is an uncommon complication resulting from surgery, radiation or trauma. Although various surgical procedures for the treatment of an RUF have been described, none has gained acceptance as the procedure of choice. The aim of this study was to review our experience with surgical management of RUF.

Methods: The outcomes of 6 male patients (mean age, 51 years) with an RUF who were operated on by a single surgeon between May 2005 and July 2012 were assessed.

Results: The causes of the RUF were iatrogenic in four cases (two after radiation therapy for rectal cancer, one after brachytherapy for prostate cancer, and one after surgery for a bladder stone) and traumatic in two cases. Fecal diversion was the initial treatment in five patients. In one patient, fecal diversion was performed simultaneously with definitive repair. Four patients underwent staged repair after a mean of 12 months. Rectal advancement flaps were done for simple, small fistula (n = 2), and flap interpositions (gracilis muscle flap, n = 2; omental flap, n = 1) were done for complex or recurrent fistulae. Urinary strictures and incontinence were observed in patients after gracilis muscle flap interposition, but they were resolved with simple treatments. The mean follow-up period was 28 months, and closure of the fistula was achieved in all five patients (100%) who underwent definitive repairs. The fistula persisted in one patient who refused further definitive surgery after receiving only a fecal diversion.

Conclusion: Depending on the severity and the recurrence status of RUF, a relatively simple rectal advancement flap repair or a more complex gracilis muscle or omental flap interposition can be used to achieve closure of the fistula.

키워드

Rectal fistula; Urinary fistula; Surgical flap; Complication
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