Transanal Minimally Invasive Proctectomy With Two-Stage Turnbull-Cutait Pull-Through Coloanal Anastomosis for Iatrogenic Rectourethral Fistulas

Beatriz Martín-Pérez, Ron Dar, Gabriele Bislenghi, Jasper Stijns, Tine Grégoir, Albert M. Wolthuis, André Dhoore

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

INTRODUCTION: Rectourethral fistula is an uncommon pathology, usually iatrogenic, occurring as a complication of surgical or ablative treatments for prostate or rectal cancer. Among other surgical techniques, restorative ultralow rectal anterior resection may be an option of last resort to achieve fistula closure avoiding the need for a permanent stoma. This article aims to describe a transanal minimally invasive-assisted Turnbull-Cutait technique for radiated rectourethral fistulas with a complementary video. TECHNIQUE: Turnbull-Cutait pull-through with delayed coloanal anastomosis technique with a proctectomy by transanal minimally invasive surgery and loop ileostomy was performed in 3 patients who developed delayed rectourethral fistula after prostate cancer treatment. Ileostomy was reversed after fistula closure confirmation. RESULTS: The first patient had brachytherapy with no surgery. The second patient had radical prostatectomy and adjuvant radiotherapy, developing the fistula after a pelvic abscess drained transrectally. The third patient underwent prostatectomy and brachytherapy, developing the fistula after transanal endoscopic microsurgery resection of a rectal villous polyp. Surgical intervention and postoperative recovery was uneventful. Fistula closure was confirmed in the 3 cases, and all ileostomies were closed without further recurrence at follow-up. CONCLUSIONS: Transanal minimally invasive proctectomy-assisted Turnbull-Cutait procedure for the treatment of rectourethral fistula is a new combination of already existing techniques, enabling the creation of safe colorectal anastomosis in high-risk cases. Given the difficulty obtaining healing with sphincter preservation in cases of postradiation rectourethral fistula, this technique aids in fistula closure and restoration of the intestinal continuity, and potentially represents an added resource in the surgical armamentarium for this challenging pathology.

Original languageEnglish
Pages (from-to)E26-E29
JournalDiseases of the Colon and Rectum
Volume64
Issue number2
DOIs
StatePublished - 1 Feb 2021
Externally publishedYes

Bibliographical note

Publisher Copyright:
© The ASCRS 2020.

Keywords

  • Proctectomy
  • Prostate cancer
  • Radiotherapy
  • Rectourethral fistula
  • Transanal minimally invasive surgery
  • Turnbull-Cutait

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