Outcomes after recto-anastomosis fistula repair in patients who underwent radical prostatectomy for prostate cancer

TY - JOUR

T1 - Outcomes after recto-anastomosis fistula repair in patients who underwent radical prostatectomy for prostate cancer

AU - Pfalzgraf, Daniel

AU - Isbarn, Hendrik

AU - Reiss, Philip

AU - Meyer-Moldenhauer, Wolf-Hartmut

AU - Fisch, Margit

AU - Dahlem, Roland

N1 - © 2013 The Authors. BJU International © 2013 BJU International.

PY - 2014/4/1

Y1 - 2014/4/1

N2 - OBJECTIVES: 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). 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.PATIENTS AND METHODS: A retrospective study of patients treated for recto-urethral fistulae after RP between 1993 and 2008. 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. Surgical technique: fistula closure was abdominal in 10 patients, perineal in five and combined abdominal and perineal in two, some with tissue interposition.RESULTS: 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. In two of the 17 patients, rectal injury during the initial surgery was reported; another three had undergone adjuvant radiation therapy (18%). In 2011, another two patients were deceased; the mean (range) follow-up was 99.5 (44-184) months. 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.CONCLUSION: 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.

AB - OBJECTIVES: 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). 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.PATIENTS AND METHODS: A retrospective study of patients treated for recto-urethral fistulae after RP between 1993 and 2008. 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. Surgical technique: fistula closure was abdominal in 10 patients, perineal in five and combined abdominal and perineal in two, some with tissue interposition.RESULTS: 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. In two of the 17 patients, rectal injury during the initial surgery was reported; another three had undergone adjuvant radiation therapy (18%). In 2011, another two patients were deceased; the mean (range) follow-up was 99.5 (44-184) months. 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.CONCLUSION: 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.

KW - Aged

KW - Anastomosis, Surgical

KW - Humans

KW - Male

KW - Middle Aged

KW - Prostatectomy

KW - Prostatic Neoplasms

KW - Quality of Life

KW - Rectal Fistula

KW - Recurrence

KW - Reoperation

KW - Retrospective Studies

KW - Treatment Outcome

KW - Urethral Diseases

KW - Urinary Fistula

KW - Urinary Incontinence

U2 - 10.1111/bju.12254

DO - 10.1111/bju.12254

M3 - SCORING: Journal article

C2 - 24053507

VL - 113

SP - 568

EP - 573

JO - BJU INT

JF - BJU INT

SN - 1464-4096

IS - 4

ER -