Management of rectal injury and rectourinary fistula from radical prostatectomy

OBJECTIVE: This study aimed to demonstrate our management of rectal injury (RI) and rectourinary fistula (RUF) from radical prostatectomy (RP) and identify a possible factor that increased the chance of developing RUF. MATERIALS AND METHODS: Between January 2011 and December 2019, a total of 14 cases of RI were retrospectively reviewed and analyzed, including preoperative, perioperative, and postoperative information. RESULTS: In all 14 cases of RI, the average age at RP was 66.3 years (54–77). During the study period, 8 of 14 cases of RI occurred in our hospital, and the incidence of RI was 0.42%. RI was intraoperative recognition in 8 cases and delayed diagnosis in 6 cases. For immediate recognition, 4 of 8 cases were primarily repaired without developing RUF and did not require diverting colostomy and suprapubic cystostomy. RUF occurred in 10 cases including 4 cases of intraoperative recognition and all cases of delayed diagnosis. In a subgroup analysis of RI that occurred in our hospital, the timing for diagnosis was clinically and statistically significant difference (P = 0.029). Instantly detected RI during RP and intraoperative rectal repair resulted in no postoperative complication. Among all 10 cases of RUF, 5 cases were successfully repaired by modified York–Mason procedure with dartos tissue flap interposition. No major complications were reported. CONCLUSIONS: Incidence of RI was 0.42% and intraoperative recognition of RI was a key to prevent the development of RUF. Modified York–Mason procedure with dartos tissue flap interposition was an effective treatment for RUF.