Conservative management of rectourethral fistula: modern treatment


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Abstract

Introduction & Objectives. Rectal injury and recto-urethral fistula (RUF) formation are severe complications after surgical treatment of prostate cancer . There are various surgical techniques as well as conservative methods for the treatment of RUF. Nonsurgical approach can be used in nontoxic, minimally symptomatic patients. Materials & Methods. From 2012 to 2016, 825 patients (mean age 68y) with LPR to be performed were recruited in the study. Postoperatively RUF developed in 7 patients (0.8%) in average in 10 days after surgery. Five cases were uncomplicated presented with pneumaturia, dysuria or urine per rectum. Two patients with fecaluria and previous history of radiotherapy or androgen deprivation were excluded from the study group. Conservative management include: 1)bowel rest 2)broad-spectrum antibiotics after urine culture 3) fully absorbable diet (combination of parenteral and enteral nutrition) 4) bladder drainage (urethral catheter or suprapubic tube). Duration of conservative treatment was 4 weeks. After treatment all patients underwent a voiding cystourethrogram. Results. During the treatment one patient has developed severe UTIs and surgical treatment were perfomed. The remaining 4 patients had spontaneous healing of the fistula and normal cystourethrogram. With the median follow up of 24 month after RUF treatment all 4patients had no fistula signs and they were fully continent. Overall RUF closure using nonsurgical treatment was successful in 4 of 5 cases (80%). Conclusions. Conservative management of RUF is a highly effective option which can be used to avoid major surgery and temporary colostomy. Nonsurgical treatment is a feasible method in selected patients with RUF.

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About the authors

S. V. Popov

St. Petersburg Clinical Hosital named after St Luka

Email: doc.popov@gmail.com
MD, PhD, Dr. Med. Sci., Head Doctor Saint-Petersburg, Russia

I. N Orlov

St. Petersburg Clinical Hosital named after St Luka

Email: doc.orlov@gmail.com
MD, PhD. Director of urologic department Saint-Petersburg, Russia

N. K Gadjiev

Saint Petersburg Pavlov State Medical University

Email: nariman.gadjiev@gmail.com
MD, PhD, Head of endourology department Saint-Petersburg, Russia

V. M Obidnyak

Saint Petersburg Pavlov State Medical University

Email: v.obidniak@gmail.com
urologist, MD, Department of Urology. Saint-Petersburg, Russia

D. A Sytnik

St. Petersburg Clinical Hosital named after St Luka

Email: doc.dmitriysytnik@gmail.com
urologist, MD, Department of Urology Saint-Petersburg, Russia

A. Y Kulikov

Sechenov University

Email: dr.a.kulikov@gmail.com
urologist, MD, Department of Urology, Institute for Urology and Reproductive Health Saint-Petersburg, Russia

G. N Akopyan

Sechenov University

Email: docgagik@mail.ru
MD, PhD Moscow, Russia

Z. K Gadzhieva

Institute for Urology and Reproductive Health, Sechenov University

Email: zgadzhieva@ooorou.ru
MD, PhD Moscow, Russia

N. Y. Spiridonov

medical clinic «MedClub»

Email: dr.spiridonov94@mail.ru
urologist, MD Saint-Petersburg, Russia

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