A New Technique to Repair Vesicorectal Fistula: Overlapping Rectal Muscle Plasty by Transanal Endoscopic Surgery

Urol Int. 2021;105(3-4):309-315. doi: 10.1159/000512379. Epub 2021 Jan 11.

Abstract

Objective: To evaluate clinical results of a novel surgical technique, we developed to repair vesicorectal fistula (VRF) occurring after prostatectomy, hospital records of the patients, who underwent the new surgical treatment, were assessed.

Methods: The novel surgical technique is called "overlapping rectal muscle plasty," which is performed under transanal endoscopic microsurgery (TEM). During the new procedure, a complete fistulectomy was first performed, and then the proper muscle layer of the rectum was folded, overlapped, and sutured to create a thick wall between the rectum and urinary bladder. This operation was carried out in 15 patients with VRF following radical prostatectomy.

Results: The operation was safely performed in all patients with an average time of 127.2 min. Fistula was corrected in 13 patients (86.7%), who were then freed from both urinary and intestinal diversions.

Conclusions: Overlapping rectal muscle plasty by TEM is a safe procedure. The success rate seems to be acceptable in selected patients. This new repair method may be considered as a minimally invasive option in the surgical treatment of VRF after prostatectomy.

Keywords: Rectovesical fistula; Surgical treatment; Transanal endoscopic microsurgery; Vesicorectal fistula.

MeSH terms

  • Aged
  • Anal Canal
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications / surgery*
  • Prostatectomy*
  • Rectal Fistula / surgery*
  • Rectum / surgery*
  • Retrospective Studies
  • Transanal Endoscopic Surgery*
  • Treatment Outcome
  • Urinary Bladder Fistula / surgery*
  • Urologic Surgical Procedures / methods