OBJECTIVES: To assess fistula recurrence rate and quality of life after repair as well as the impact on continence and erection in patients with recto-anastomotic fistula after radical prostatectomy.
Even in the more recent publications the number of cases for recto-urinary fistulas after radical prostatectomy is relatively small. Success rates at fistula closure are good; however data regarding functional outcome and quality of life is more restricted.
PATIENTS AND METHODS: Retrospective study of patients treated for recto-urethral fistulas after radical prostatectomy between 1993 and 2008. All 17 patients were assessed for fistula recurrence in 2007 and received a standardized non-validated questionnaire to assess quality of life in 2011; furthermore, a patient's chart review was performed. Surgical technique: fistula closure was abdominal in ten patients, perineal in 5 and combined abdominal and perineal in two, some with tissue interposition.
RESULTS: In 2007, follow-up was available for 14 patients, 1 was deceased, 2 lost to follow-up. Mean follow-up was 73.3 months, mean patient age 63 years. In 2 patients, rectal injury during the initial surgery was reported; another 3 had undergone adjuvant radiation therapy (18%). In 2011, another 2 patients were deceased; mean follow-up was 99.5 months (range, 44-184). A strong improvement in Qol as compared to before surgery was found in 58% of patients, a slight improvement in 8%, no change in quality of life in 25%. 67% are very satisfied with the surgery, 33% are satisfied.
CONCLUSIONS: Perineal or abdominal fistula repair yields excellent success rates and high patient satisfaction. However, urinary incontinence can be found in a number of patients postoperatively, requiring further treatment.
Written by:
Pfalzgraf D, Isbarn H, Reiss P, Meyer-Moldenhaue WH, Fisch M, Dahlem R. Are you the author?
University Medical Centre Hamburg-Eppendorf, Department of Urology, Hamburg, Germany.
Reference: BJU Int. 2013 May 23. Epub ahead of print.
doi: 10.1111/bju.12254
PubMed Abstract
PMID: 24053507
UroToday.com Prostate Cancer Section
