York‐Mason procedure for repair of recto‐urinary fistulae: a 40‐year experience

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Our previous report, almost 10 years ago, on the York‐Mason procedure was the largest series on this procedure. That report concluded that the York‐Mason posterior, trans‐anal, trans‐rectal correction of iatrogenic recto‐urinary fistula was highly successful, reliable and safe – when employed for small fistulas following prostate surgery. Since then, many other smaller case series have confirmed our success. This study provides a continuing body of evidence of the success, reliability, and safety by the largest York‐Mason series in the literature, and our numbers have now doubled in less than 10 years. Avoiding preliminary fecal diversion after surgical injury, which we proposed on our previous report, has now been observed to be safe and reliable with long‐term follow up. We also tried to push the limits of the surgery into larger, radiated fishtulas, but unfortunately were met with poorer outcomes. OBJECTIVE To review the use of the York‐Mason transanal, transrectal procedure, used in properly selected patients over a 40‐year period, for repairing recto‐urinary fistulae. PATIENTS AND METHODS We retrospectively reviewed the medical records of all patients who underwent acquired recto‐urethral or rectovesical fistula repair at our institution. A total of 51 patients have undergone York‐Mason recto‐urinary fistula repair at our institution during this time. RESULTS Since our last report in 2003, we have performed this procedure an additional 27 times. We continue to have good results, with 25 of these patients having resolution of their fistulae after one procedure. Failures in the updated cohort were radiation‐induced fistulae. We continue to find no evidence of faecal incontinence or stenosis after this procedure. CONCLUSIONS Over a period of 40 years, the York‐Mason posterior, transanal, transrectal correction of iatrogenic recto‐urinary fistula has been highly successful, reliable and safe, when used for fistulae occurring after prostate surgery. Preliminary faecal diversion can often be avoided in selected patients.