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Medina LG, Lee RA, Celis V, Rodriguez V, Poncel J, Sayegh AS, Sotelo R. Robotic management of urinary fistula. Asian J Urol 2024; 11:357-365. [PMID: 39139533 PMCID: PMC11318412 DOI: 10.1016/j.ajur.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/13/2023] [Indexed: 08/15/2024] Open
Abstract
Objectives To highlight critical preoperative and intraoperative considerations in approaching fistula repair robotically. Methods A search of the literature was conducted to identify relevant articles pertaining to robotic management of urinary fistulae. Results Fistulae of the genitourinary tract can be a challenging dilemma for urologists, as definitive management may require surgical intervention. Pathogenesis of both enteric and non-enteric fistulae are multifactorial, and successful repair hinges on the meticulous perioperative evaluation, planning, and execution. Traditional open techniques can subject patients to increased morbidity and prolonged hospitalizations. Since its introduction, the robotic surgical platform has continued to expand its indications. Its three-dimensional visualization and tremor free wristed instrument movements have made the robotic platform an attractive option for genitourinary fistula reconstruction. Conclusion Robotic management of complex urinary fistulae is feasible in expert hands; more studies are needed to define its role in the treatment algorithm of this devastating conditions.
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Affiliation(s)
- Luis G. Medina
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Randall A. Lee
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Division of Urology, Department of Surgery, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Valeria Celis
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Veronica Rodriguez
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jaime Poncel
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Aref S. Sayegh
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rene Sotelo
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Sayegh AS, La Riva A, Perez LC, Medina LG, Poncel J, Ortega DG, Lizana MA, Forsyth E, Sotelo R. Robotic Simultaneous Repair of Rectovesical Fistula With Vesicourethral Anastomotic Stricture after Radical Prostatectomy: Step-by-Step Technique and Outcomes. Urology 2023:S0090-4295(23)00164-4. [PMID: 36822246 DOI: 10.1016/j.urology.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/19/2023] [Accepted: 02/05/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVE To report our experience and outcomes using a novel robotic technique for the simultaneous repair of rectovesical fistula (RVF) with vesicourethral anastomotic stricture (VUAS) after radical prostatectomy (RP). METHODS Between 2019 and 2021, four consecutive patients who underwent robotic-assisted simultaneous repair of RVF with concurrent VUAS after RP were retrospectively reviewed. Baseline characteristics and perioperative outcomes were examined and reported. Complications were graded using the modified Clavien-Dindo classification system and the European Association of Urology Complications Panel Assessment and Recommendations. RESULTS Four cases with a median age of 68.5 (63.3-72.3) years were treated. Interposition omentum flaps were used in all our cases. One case had perineal urethral mobilization to reach healthy urethral margins and tension-free vesicourethral anastomosis. Surgeries were uneventful, with no intraoperative complications reported. Median operative time, estimated blood loss, and length of hospital stay were 370 (291.3-453) minutes, 255 (175-262.5) mL, and 2.5 (2-3) days, respectively. Median Jackson-Pratt drains, Double-J stents and Foley catheter removal days were 6 (6-10), 38 (32-43), and 30 (27-41) days, respectively. No postoperative complications were reported. The median follow-up time was 16.25 (12-26) months, and no fistula recurrence was shown. CONCLUSION Robotic-assisted laparoscopic repair could represent an effective approach for the simultaneous repair of RVF with concomitant VUAS. More studies and management standardization are needed to assess the role of the robotic platform in the simultaneous repair of RVF with VUAS after radical prostatectomy.
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Affiliation(s)
- Aref S Sayegh
- Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Anibal La Riva
- Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA; Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Laura C Perez
- Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Luis G Medina
- Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jaime Poncel
- Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - David G Ortega
- Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Maria A Lizana
- Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Edward Forsyth
- Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Rene Sotelo
- Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA.
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Medina LG, Riva AL, Perez LC, Sayegh AS, Ortega DG, Rangel E, Hernandez AB, Lizana MA, Aponte HA, Sanchez A, Polotti CF, Cacciamani GE, Sotelo R. Minimally Invasive Management of Post-treatment Rectovesical Fistulae. J Endourol 2023; 37:185-190. [PMID: 36150030 DOI: 10.1089/end.2022.0266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective: The aim of this study is to report our experience in minimally invasive management of rectovesical fistulae (RVFs). Materials and Methods: Between 2004 and 2021, 24 patients who underwent minimally invasive RVF repair by a single surgeon at 3 international institutions were retrospectively reviewed. Baseline demographic characteristics and perioperative and postoperative variables were collected. Complications were reported using the modified Clavien-Dindo Classification System and the European Association of Urology Complication Guidelines Panel Assessment and Recommendations. Fistula repair was defined as confirmation of fistula closure by imaging and complete resolution of fistula-related symptoms at the 12-month follow-up. Continuous variables are reported as medians and quartiles, whereas categorical variables are reported as frequencies and percentages. Results: Twenty-four patients with RVFs were treated: 22 males (91.7%) and 2 females with a median age of 66 (64.2-68) years. Twenty cases (83.3%) occurred postsurgery, three cases (12.5%) after surgery with combined radiotherapy, and one case (4.1%) after a combination of energy treatments. A robotic approach was performed in 19 patients (79%) and laparoscopic approach in 5 patients (21%). Ninety-six percent of patients had previous fecal diversions. No intraoperative complications were recorded. The median operative time was 180 (140-282) minutes, estimated blood loss was 50 (40-125) mL, and length of hospital stay was 2 (2-3) days. There were two Grade II complications and one Grade IIIb complication. All patients met criteria for repair. Conclusions: Minimally invasive management of RVFs is feasible. More studies are needed to assess the role of this approach among all RVF management options.
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Affiliation(s)
- Luis G Medina
- USC Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - Anibal La Riva
- USC Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - Laura C Perez
- USC Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - Aref S Sayegh
- USC Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - David G Ortega
- USC Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - Enanyeli Rangel
- USC Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - Angelica B Hernandez
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Maria A Lizana
- USC Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - Hernan A Aponte
- Fundación Universitaria Ciencias de la Salud, Hospital de San José, Bogotá, Colombia
| | - Alexis Sanchez
- Robotic Surgery Program Medicine Faculty, University Hospital of Caracas, Central University of Venezuela, Caracas, Venezuela
| | - Charles F Polotti
- USC Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - Giovanni E Cacciamani
- USC Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - Rene Sotelo
- USC Institute of Urology, University of Southern California, Los Angeles, California, USA
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Medina LG, Sayegh AS, La Riva A, Perez LC, Ortega DG, Rangel E, Hernandez AB, Lizana MA, Sanchez A, Polotti CF, Cacciamani GE, Sotelo R. Minimally Invasive Management of Rectourethral Fistulae. Urology 2022; 169:102-109. [PMID: 36002087 DOI: 10.1016/j.urology.2022.05.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/10/2022] [Accepted: 05/22/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To report our experience and outcomes in minimally invasive management of rectourethral fistula (RUF). METHODS From 2004 to 2021, 15 patients who underwent minimally invasive RUF repair by a single surgeon at 2 international institutions were retrospectively reviewed. Baseline demographic characteristics, perioperative, and postoperative data were collected. Complications were reported using the modified Clavien-Dindo Classification System and the European Association of Urology Complication Panel Assesment and Recommendations. Success was defined as complete resolution of fistula-related symptoms at 12-month follow-up along with confirmation of fistula closure by imaging or cystoscopy. Categorical variables were presented as frequencies and percentages whereas continuous variables were reported as median and quartiles. RESULTS Fifteen male patients with a median age of 71 (64-79.2) years were treated. Four cases (26.6%) occurred postsurgery, 8 cases (53.3%) occurred after energy treatments, and 3 cases (20%) after surgery combined with an energy treatment modality. A robotic and laparoscopic approach was performed in 9 (60%) and 6 (40%) patients, respectively. No intraoperative complications were reported. Median operative time was 264 (217.5-341) minutes, estimated blood loss was 175 (137.5-200) mL, and the length of hospital stay was 4 days. Nine postoperative complications were reported. All patients were followed-up for 12 months with no recurrence reported. All patients reached our criteria for successful RUF repair. CONCLUSIONS Minimally invasive surgery could represent an efficient way to manage RUF in selected patients. More studies and treatment standardization are needed to assess the role of minimally invasive surgery in the management of RUF.
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Affiliation(s)
- Luis G Medina
- USC Institute of Urology, University of Southern California, Los Angeles, CA
| | - Aref S Sayegh
- USC Institute of Urology, University of Southern California, Los Angeles, CA
| | - Anibal La Riva
- USC Institute of Urology, University of Southern California, Los Angeles, CA
| | - Laura C Perez
- USC Institute of Urology, University of Southern California, Los Angeles, CA
| | - David G Ortega
- USC Institute of Urology, University of Southern California, Los Angeles, CA
| | - Enanyeli Rangel
- USC Institute of Urology, University of Southern California, Los Angeles, CA
| | | | - Maria A Lizana
- USC Institute of Urology, University of Southern California, Los Angeles, CA
| | - Alexis Sanchez
- Universidad Central de Venezuela, Hospital Universitario de Caracas, Venezuela
| | - Charles F Polotti
- USC Institute of Urology, University of Southern California, Los Angeles, CA
| | | | - Rene Sotelo
- USC Institute of Urology, University of Southern California, Los Angeles, CA.
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Wofford A, Congleton JY, Bienvenu JM. EDITORIAL COMMENT. Urology 2022; 169:108-109. [DOI: 10.1016/j.urology.2022.05.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/22/2022] [Indexed: 11/11/2022]
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Takeda T, Shonaka T, Tani C, Hayashi T, Kakizaki H, Sumi Y. Gracilis muscle flap combined with a laparoscopic transabdominal approach is effective in the treatment of post-prostatectomy rectourethral fistula: A case report. Int J Surg Case Rep 2022; 92:106856. [PMID: 35276434 PMCID: PMC8917308 DOI: 10.1016/j.ijscr.2022.106856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/20/2022] [Accepted: 02/22/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Case presentation Clinical discussion Conclusion The rectourethral fistula is a rare complication of total prostatectomy, but when it becomes intractable, it is difficult to treat. Surgical treatment is required, but there is no standard technique. We used a laparoscopic approach in combination with gracilis muscle flap filling via a transperineal approach. To our knowledge, this technique has only been reported in only one other case in the Japanese literature. In a case of high rectourethral fistula, the gracilis muscle flap with a laparoscopic approach allowed for safe and secure flap filling.
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Affiliation(s)
- Tomohiro Takeda
- Division of Gastrointestinal Surgery, Department of Surgery, Asahikawa Medical University, 2-1, Midorigaoka-Higashi, Asahikawa 078-8510, Japan.
| | - Tatsuya Shonaka
- Division of Gastrointestinal Surgery, Department of Surgery, Asahikawa Medical University, 2-1, Midorigaoka-Higashi, Asahikawa 078-8510, Japan
| | - Chikayoshi Tani
- Division of Gastrointestinal Surgery, Department of Surgery, Asahikawa Medical University, 2-1, Midorigaoka-Higashi, Asahikawa 078-8510, Japan
| | - Toshihiko Hayashi
- Department of Plastic and Reconstructive Surgery, Asahikawa Medical University, 2-1, Midorigaoka-Higashi, Asahikawa 078-8510, Japan
| | - Hidehiro Kakizaki
- Department of Renal and Urologic surgery, Asahikawa Medical University, 2-1, Midorigaoka-Higashi, Asahikawa 078-8510, Japan
| | - Yasuo Sumi
- Division of Gastrointestinal Surgery, Department of Surgery, Asahikawa Medical University, 2-1, Midorigaoka-Higashi, Asahikawa 078-8510, Japan
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