V13-11 Single Port Robotic Trans-Anal Rectourethral Fistula Repair

You have accessJournal of UrologyLower Tract Reconstruction (including Transgender) II (V13)1 May 2024V13-11 SINGLE PORT ROBOTIC TRANS-ANAL RECTOURETHRAL FISTULA REPAIR Hafiz Umair Siddiqui, Michael D. Gross, David Liska, Hadley Wood, and Mohamed Eltemamy Hafiz Umair SiddiquiHafiz Umair Siddiqui , Michael D. GrossMichael D. Gross , David LiskaDavid Liska , Hadley WoodHadley Wood , and Mohamed EltemamyMohamed Eltemamy View All Author Informationhttps://doi.org/10.1097/01.JU.0001009532.52598.9a.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Rectourethral fistula is an infrequent but serious complication of radical prostatectomy. While small fistulae are said to be able to be managed with cystoscopic fulguration, most cases will require definitive surgical repair via an extensive perineal or transabdominal approach. METHODS: We present the case of a 63-year-old male who had undergone radical prostatectomy four years prior, complicated by a rectourethral fistula with bothersome urinary leakage per rectum. The patient had failed cystoscopic fulguration twice with only temporary relief of symptoms. He had fortunately never received any radiation therapy in his treatment course. In collaboration with the colorectal surgery team, he underwent a diverting colostomy in anticipation of definitive surgical repair. Given the small caliber of the fistula as well as its distal location, the trans-anal approach was chosen for a minimally invasive repair. RESULTS: The patient underwent a robotic single port trans-anal rectourethral fistula repair. Cystoscopy was performed and a ureteral catheter placed through the fistula and out the anus for identification. A 4cm wound retractor was used to dock the robot just proximal to the anal sphincter. The fistulous tract was dissected circumferentially and excised and the bladder defect closed with 3-0 vicryl in figure-of-eight fashion. A hemostatic clip was present adjacent to the fistula which likely contributed to localized inflammation and impaired healing. The rectal mucosa was then closed with a running 3-0 absorbable barbed suture. Post-operative voiding cystourethrogram at the time of foley removal three weeks post-operatively showed an intact repair with no residual fistula or leak. He underwent colostomy reversal three months following the above repair. CONCLUSIONS: Trans-anal repair of small rectourethral fistulae is a feasible approach utilizing the single port robot via pre-existing space within the rectum. The technique relies on easily translatable basic robotic principles and offers a minimally invasive alternative to the traditional repair. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1159 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Hafiz Umair Siddiqui More articles by this author Michael D. Gross More articles by this author David Liska More articles by this author Hadley Wood More articles by this author Mohamed Eltemamy More articles by this author Expand All Advertisement PDF downloadLoading ...