Document Detail


Acquired rectourethral fistulas in adults: a systematic review of surgical repair techniques and outcomes.
MedLine Citation:
PMID:  23392154     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Rectourethral fistulas are uncommon. Retrospective studies and case reports have highlighted various approaches for surgical repair. Because clinical presentations and technical expertise vary widely, no single procedure has been universally adopted.
OBJECTIVE: We sought to qualitatively analyze studies describing surgical techniques and outcomes in adult acquired rectourethral fistulas to outline universal approaches for evaluation and management.
DATA SOURCES: MEDLINE (PubMed, Ovid) and the Cochrane Library were searched by using the terms rectourethral fistulas, recto-urethral fistulas, urethrorectal fistulas, and prostatourethral-rectal fistulas.
STUDY SELECTION: All studies were retrospective, in English, and reported at least 4 cases. Any series with >50% congenital cases or <50% adults (19+ years) was excluded. Of the 569 records identified, 26 articles were included.
INTERVENTION: The intervention was surgical repair of rectourethral fistula.
MAIN OUTCOME MEASURES: The main outcome measures were successful fistula closure, fistula recurrence or persistence, and permanent fecal and/or urinary diversion.
RESULTS: Four hundred sixteen patients were identified, including 169 (40%) who had previous pelvic irradiation and/or ablation. Most patients (90%) underwent 1 of 4 categories of repair: transanal (5.9%), transabdominal (12.5%), transsphincteric (15.7%), and transperineal (65.9%). Tissue interposition flaps, predominantly gracilis muscle, were used in 72% of repairs. The fistula was successfully closed in 87.5%. Overall permanent fecal and/or urinary diversion rates were 10.6% and 8.3%. Most high-volume centers (≥25 patients) performed transperineal repairs with tissue flaps in 100% of cases.
LIMITATIONS: This review was limited by the heterogeneity of repairs and bias toward preferred surgical approaches in single-center studies.
CONCLUSIONS: Regardless of complexity, rectourethral fistulas have an initial closure rate approaching 90% when the transperineal approach is used. Permanent fecal and/or urinary diversion should be a last resort in patients with devastated, nonfunctional fecal and urinary systems.
Authors:
Elizabeth M Hechenbleikner; Jill C Buckley; Elizabeth C Wick
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Diseases of the colon and rectum     Volume:  56     ISSN:  1530-0358     ISO Abbreviation:  Dis. Colon Rectum     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-08     Completed Date:  2013-04-15     Revised Date:  2013-07-24    
Medline Journal Info:
Nlm Unique ID:  0372764     Medline TA:  Dis Colon Rectum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  374-83     Citation Subset:  IM    
Affiliation:
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Humans
Reconstructive Surgical Procedures*
Rectal Fistula / complications,  surgery*
Treatment Outcome
Urethral Diseases / complications,  surgery*
Urinary Fistula / complications,  surgery*
Comments/Corrections
Comment In:
Dis Colon Rectum. 2013 Jul;56(7):e346   [PMID:  23739207 ]
Dis Colon Rectum. 2013 Jul;56(7):e347   [PMID:  23739208 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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