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Bernard C, Bentellis I, El-Akri M, Durand M, Guérin O, Cornu JN, Cousin T, Gaillard V, Dupuis H, Tricard T, Hermieu N, Lecoanet P, Bruyère F, Capon G, Biardeau X, Karam E, Saussine C, Hermieu JF, Peyronnet B, Game X, Brierre T. Primary implantation of an artificial urinary sphincter using the perineal and penoscrotal approaches: Functional results and assessment of reoperative procedures. Fr J Urol 2024; 34:102604. [PMID: 38417628 DOI: 10.1016/j.fjurol.2024.102604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/18/2024] [Accepted: 02/20/2024] [Indexed: 03/01/2024]
Abstract
INTRODUCTION Artificial urinary sphincter (AUS) is the standard treatment for severe stress urinary incontinence in men. While the perineal access is considered the gold standard, some authors have proposed penoscrotal AUS in order to facilitate the procedure. The main objective of our study was to evaluate the duration of survival without revision surgery (SSRC) according to the surgical approach for primary implantation. MATERIAL AND METHODS Data from 1179 patients implanted in France between 1991 and 2020 with an AMS 800 AUS were retrospectively analyzed. A total of 762 men were implanted perineally (VP) and 417 penoscrotally (VPS). RESULTS Median follow-up was 20 vs. 25months respectively. The groups were equivalent overall, apart from the use of anticoagulants (11% VP vs. 6.3% VPS P=0.014). In our population, 54% patients were considered as "dry" in the case of VPS vs. 42% for VP. There was no significant difference in terms of survival time without reoperation, revision, replacement or explantation. In univariate and multivariate analysis, age over 70years was predictive of more reinterventions, whereas the use of a 4.5cm cuff was protective, with hazard ratios of 1.42 (P=0.001) and 0.78 (P=0.04), respectively. CONCLUSION The penoscrotal approach does not appear to be associated with more complications, has good functional results and no significant difference in reoperation-free survival. A prospective multicenter non-inferiority study could be of interest to confirm our findings. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Clémence Bernard
- Department of Urology, Renal Transplantation and Andrology, CHU Rangueil, TSA 50032, 31059 Toulouse, France.
| | - Imad Bentellis
- Urology Department, Nice University Hospital, Nice, France
| | - Mehdi El-Akri
- Urology Department, Rennes University Hospital, Rennes, France
| | | | - Olivier Guérin
- Urology Department, Nice University Hospital, Nice, France
| | | | - Tiffany Cousin
- Urology Department, Bordeaux University Hospital, Bordeaux, France
| | | | - Hugo Dupuis
- Urology Department, CHU de Rouen, Rouen, France
| | | | | | - Pierre Lecoanet
- Urology Department, Nancy University Hospital, Nancy, France
| | | | - Grégoire Capon
- Urology Department, Bordeaux University Hospital, Bordeaux, France
| | - Xavier Biardeau
- Urology Department, Lille University Hospital, Lille, France
| | - Elias Karam
- Visceral Surgery and Liver Transplant Unit, CHU de Tours, Tours, France
| | | | | | | | - Xavier Game
- Department of Urology, Renal Transplantation and Andrology, CHU Rangueil, TSA 50032, 31059 Toulouse, France
| | - Thibaut Brierre
- Department of Urology, Renal Transplantation and Andrology, CHU Rangueil, TSA 50032, 31059 Toulouse, France
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Galán C, Hernández MP, Martínez MC, Sánchez A, Bollo J, Targarona EM. Surgical treatment of retrorectal tumors: a plea for a laparoscopic approach. Surg Endosc 2023; 37:9080-9088. [PMID: 37798533 PMCID: PMC10709236 DOI: 10.1007/s00464-023-10448-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/05/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION Retrorectal tumors (RRTs) are rare and often surgically excised due to the risk of malignant degeneration and compressive or obstructive symptoms. The approach for excision has traditionally been based on tumor location and performed using either a transabdominal or perineal approach depending on the position of the tumor. The advent of minimally invasive surgery, however, has challenged this paradigm. Here, we determined the applicability and potential advantages of a laparoscopic transabdominal approach in a series of 23 patients with RRTs. MATERIAL AND METHODS We included 23 patients presenting with RRTs treated at the Surgical Gastrointestinal Unit at Hospital de Sant Pau that were registered prospectively since 1998. The preoperative evaluation consisted of colonoscopy, CT scan and/or MRI, mechanical bowel lavage, and antibiotic therapy. Signed consent was obtained from all patients for a laparoscopic transabdominal approach unless the tumor was easily accessible via a perineal approach. In case of recurrence, a transanal endoscopic microsurgery (TEM) approach was considered. Surgical details, immediate morbidity, and short- and long-term outcomes were recorded. RESULTS Of the 23 RRT cases evaluated, 16 patients underwent a laparoscopic transabdominal approach and 6 underwent a perineal approach. No patients required conversion to open surgery. In the laparoscopic transabdominal group, the mean operating time was 158 min, the average postoperative hospital stay was 5 days, and postoperative morbidity was 18%. Three patients had recurrent RRTs, two of the three underwent surgical reintervention. The third patient was radiologically stable and close follow-up was decided. CONCLUSION Our results show that laparoscopic transabdominal excision of RRT is a safe and effective technique, offering the potential advantages of less invasive access and reduced morbidity. This approach challenges the traditional paradigm of excision of these infrequent tumors based solely on tumor location and offers a viable alternative for the treatment of these infrequent tumors.
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Affiliation(s)
- Clara Galán
- Unit of Gastrointestinal Surgery, Service of Surgery, Hospital de Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - M Pilar Hernández
- Unit of Gastrointestinal Surgery, Service of Surgery, Hospital de Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
- Institute for Biomedical Research, Hospital de Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - M Carmen Martínez
- Unit of Gastrointestinal Surgery, Service of Surgery, Hospital de Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
- Institute for Biomedical Research, Hospital de Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Anna Sánchez
- Unit of Gastrointestinal Surgery, Service of Surgery, Hospital de Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
- Institute for Biomedical Research, Hospital de Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Jesús Bollo
- Unit of Gastrointestinal Surgery, Service of Surgery, Hospital de Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
- Institute for Biomedical Research, Hospital de Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Eduardo Mª Targarona
- Unit of Gastrointestinal Surgery, Service of Surgery, Hospital de Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.
- Institute for Biomedical Research, Hospital de Sant Pau (IIB Sant Pau), Barcelona, Spain.
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Balci B, Yildiz A, Leventoğlu S, Mentes B. Retrorectal tumors: A challenge for the surgeons. World J Gastrointest Surg 2021; 13:1327-1337. [PMID: 34950423 PMCID: PMC8649566 DOI: 10.4240/wjgs.v13.i11.1327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 07/26/2021] [Accepted: 09/23/2021] [Indexed: 02/06/2023] Open
Abstract
Retrorectal or presacral tumors are rare lesions located in the presacral area and considered as being derived from multiple embryological remnants. These tumors are classified as congenital, neurogenic, osseous, inflammatory, or miscellaneous. The most common among these are congenital benign lesions that present with non-specific symptoms, such as lower back pain and change in bowel habit. Although congenital and developmental tumors occur in younger patients, the median age of presentation is reported to be 45 years. Magnetic resonance imaging plays a crucial role in treatment management through accurate diagnosis of the lesion, the evaluation of invasion to adjacent structures, and the decision of appropriate surgical approach. The usefulness of preoperative biopsy is still debated; currently, it is only indicated for solid or heterogeneous tumors if it will alter the treatment management. Surgical resection with clear margins is considered the optimal treatment; described approaches are transabdominal, perineal, combined abdominoperineal, and minimally invasive. Benign retrorectal tumors have favorable long-term outcomes with a low incidence of recurrence, whereas malignant tumors have a potential for distant organ metastasis in addition to local recurrence.
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Affiliation(s)
- Bengi Balci
- Department of General Surgery, Ankara Oncology Training and Research Hospital, Ankara 06060, Turkey
| | - Alp Yildiz
- Department of General Surgery, Ankara Yenimahalle Training and Research Hospital, Ankara 06370, Turkey
| | - Sezai Leventoğlu
- Department of Surgery, Gazi University Medical School, Ankara 06530, Turkey
| | - Bulent Mentes
- Department of General Surgery, Memorial Ankara Hospital, Ankara 06060, Turkey
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Chen K, Lan YZ, Li J, Xiang YY, Zeng DZ. Mine disaster survivor’s pelvic floor hernia treated with laparoscopic surgery and a perineal approach: A case report. World J Clin Cases 2020; 8:4228-4233. [PMID: 33024783 PMCID: PMC7520773 DOI: 10.12998/wjcc.v8.i18.4228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/28/2020] [Accepted: 08/19/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND A pelvic floor hernia is defined as a pelvic floor defect through which the intraabdominal viscera may protrude. It is an infrequent complication following abdominoperineal surgeries. This type of hernia requires surgical repair by conventional or reconstructive techniques. The main treatments could be transabdominal, transperineal or a combination.
CASE SUMMARY In this article, we present the case of a recurrent perineal incisional hernia, postresection of the left side of the pelvis, testis and lower limbs resulting from a mine disaster 18 years ago. Combined laparoscopic surgery with a perineal approach was performed. The pelvic floor defect was repaired by a biological mesh and one pedicle skin flap. No signs of recurrence were indicated during the 2 years of follow-up.
CONCLUSION The combination of laparoscopic surgery with a perineal approach was effective. The use of the biological mesh and pedicle skin flap to restructure the pelvic floor was effective.
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Affiliation(s)
- Kai Chen
- Department of General Surgery, The Third Affiliated Hospital of Chongqing Medical University, Chongqing 401120, China
| | - Yuan-Zhi Lan
- Department of General Surgery, The Third Affiliated Hospital of Chongqing Medical University, Chongqing 401120, China
| | - Jing Li
- Department of General Surgery, The Third Affiliated Hospital of Chongqing Medical University, Chongqing 401120, China
| | - Yuan-Yuan Xiang
- Department of General Surgery, The Third Affiliated Hospital of Chongqing Medical University, Chongqing 401120, China
| | - Dong-Zhu Zeng
- Department of General Surgery, The Third Affiliated Hospital of Chongqing Medical University, Chongqing 401120, China
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Nikolaev VV. Recurrent rectourethral fistula repair: A novel technique of gracilis muscle interposition. J Pediatr Surg 2020; 55:1974-8. [PMID: 32616414 DOI: 10.1016/j.jpedsurg.2020.05.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND A perineal approach with gracilis muscle interposition (GMI) remains the most common in recurrent rectourethral fistulas (RUFs). The closure failures in10%-20% cases and urinary incontinence in 10%-80% cases referred to the disadvantages of the perineal approach owing to neurovascular damage. This article shows that the retraction of a survived muscle gracilis flap is one of the causes of fistula recurrence, and a simpler technique of the flap interposition is presented, requiring a less invasive perineal access. METHODS Three consecutive patients with RUF at the age of 5, 13 and 15 years who underwent multiple (3, 4 and 5) unsuccessful reconstructive attempts were referred to our clinic. The last procedure was performed with GMI. In all cases, these were acquired iatrogenic fistulas that occurred after operations for Hirschsprung's disease (2) or anorectal malformation (1), and subsequent dilatation of the anus. All patients had a colostomy several years ago. Reinterposition and distant anchoring of the survived graсilis flap were performed through the perineal approach, avoiding lateral and anterolateral dissection. RESULTS The early postoperative period was uneventful. In one patient, a stricture of the posterior urethra formed. Urethrotomy was performed in 3 months, with complete restoration of micturition. The colostomy was closed in all patients after 3-4 months. In the long term follow up within 4-8 years, no fistula recurrence was noted. CONCLUSIONS The suggested traction technique of GMI allowed: to minimize the perineal access size, hence minimizing the injury and the operating time; to place the anchoring suture outside of the inflammation zone, ensuring secure attachment; to provide precise flap positioning and intimate contact between the flap and the urethra. LEVEL OF EVIDENCE Level V.
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Tasci AI, Simsek A, Sam E, Seker KG, Atar FA, Sahin S, Tugcu V. Gasless robotic perineal radical prostatectomy: Experience of the first 12 cases. ARCH ESP UROL 2020; 73:236-241. [PMID: 32240115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To present our results of first 12 patients on whom we performed gasless robotic perineal radical prostatectomy (r-PRP). METHODS We performed gasless r-PRP on 12 patients between August 2018 and October 2018. Multiparametric magnetic resonance imaging was performed forall patients to exclude local advanced disease. Demographic characteristics, technical details, and intra and postoperative data were analyzed. RESULTS The mean age of the patients was 62.6 ± 6years. The mean body mass index of the patients was 27 ± 4 kg/m2. Four patients had a history of major abdominal surgery. The mean preoperative prostate-specific antigen (PSA) was 7.4 ± 2.5 ng/mL. The mean prostate volume was 40 ± 10.2 cc. The mean perineal dissection time was 45.6 ± 5.8 minutes. The mean console time and total operative time were 117.8 ± 28.1 and 163.3 ± 30.7 minutes, respectively. The mean urethral catheter removal time was 9.2 ± 1.9 days. The immediate continence rate was 25% after the urethral catheter removal and the continence rate was 75% and 91.67% at the 3rd and 6th month follow-up, respectively. CONCLUSIONS Gasless r-PRP is an efficient and safe method in prostate cancer surgery. However, prospective randomized and comparative studies are required with large patient series.
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Affiliation(s)
- Ali Ihsan Tasci
- Department of Urology. University of Health Sciences. Bakirkoy Dr. Sadi Konuk Training and Research Hospital. Istanbul. Turkey
| | - Abdulmuttalip Simsek
- Department of Urology. University of Health Sciences. Bakirkoy Dr. Sadi Konuk Training and Research Hospital. Istanbul. Turkey
| | - Emre Sam
- Department of Urology. University of Health Sciences. Bakirkoy Dr. Sadi Konuk Training and Research Hospital. Istanbul. Turkey
| | - Kamil Gokhan Seker
- Department of Urology. University of Health Sciences. Bakirkoy Dr. Sadi Konuk Training and Research Hospital. Istanbul. Turkey
| | - Feyzi Arda Atar
- Department of Urology. University of Health Sciences. Bakirkoy Dr. Sadi Konuk Training and Research Hospital. Istanbul. Turkey
| | - Selcuk Sahin
- Department of Urology. University of Health Sciences. Bakirkoy Dr. Sadi Konuk Training and Research Hospital. Istanbul. Turkey
| | - Volkan Tugcu
- Department of Urology. University of Health Sciences. Bakirkoy Dr. Sadi Konuk Training and Research Hospital. Istanbul. Turkey
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Gallo G, Martellucci J, Pellino G, Ghiselli R, Infantino A, Pucciani F, Trompetto M. Consensus Statement of the Italian Society of Colorectal Surgery (SICCR): management and treatment of complete rectal prolapse. Tech Coloproctol 2018; 22:919-931. [PMID: 30554284 DOI: 10.1007/s10151-018-1908-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 12/09/2018] [Indexed: 12/15/2022]
Abstract
Rectal prolapse, rectal procidentia, "complete" prolapse or "third-degree" prolapse is the full-thickness prolapse of the rectal wall through the anal canal and has a significant impact on quality of life. The incidence of rectal prolapse has been estimated to be approximately 2.5 per 100,000 inhabitants with a clear predominance among elderly women. The aim of this consensus statement was to provide evidence-based data to allow an individualized and appropriate management and treatment of complete rectal prolapse. The strategy used to search for evidence was based on application of electronic sources such as MEDLINE, PubMed, Cochrane Review Library, CINAHL and EMBASE. The recommendations were defined and graded based on the current levels of evidence and in accordance with the criteria adopted by the American College of Gastroenterology's Chronic Constipation Task Force. Five evidence levels were defined. The recommendations were graded A, B, and C.
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Affiliation(s)
- G Gallo
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy.,Department of Surgical and Medical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - J Martellucci
- Department of General, Emergency and Minimally Invasive Surgery, Careggi University Hospital, Florence, Italy
| | - G Pellino
- Department of Medical, Surgical, Neurological, Metabolic and Ageing Sciences, Unit of General Surgery, Università della Campania "Luigi Vanvitelli", Naples, Italy.,Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain
| | - R Ghiselli
- Department of General Surgery, Università Politecnica delle Marche, Ancona, Italy
| | - A Infantino
- Department of Surgery, Santa Maria dei Battuti Hospital, San Vito al Tagliamento, Pordenone, Italy
| | - F Pucciani
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - M Trompetto
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy.
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Abstract
BACKGROUND Previous studies of the outcome after perineal stapled prolapse resection (PSPR) have included a limited number of patients with a short follow-up and high recurrence rates. The present study was designed to assess the initial results, complications, recurrence rate, and outcomes up to 4 years after PSPR, as well as the need for a repeated procedure. METHODS Fifty-four consecutive patients with rectal prolapse (mean age 77.2 years, range 46-93 years; n = 3 men) were selected for PSPR between May 2009 and February 2015. Prolapse length was measured at baseline and after surgery. Patients were asked to grade intensity of symptoms as a satisfaction score of 1-10, 10 representing being symptom-free. RESULTS The mean operation time was 45.3 min (SD = 17.5, range 25-95 min). The mean rectal prolapse length was reduced significantly from 9.5 cm (SD = 5.0, range 4-30 cm) to 1.2 cm (SD = 2.6, range 0-10 cm; p < 0.0001). Bleeding requiring surgical intervention occurred in two patients (3.7%). Postoperative satisfaction score increased from a mean of 2.2 (SD = 0.9) to a mean of 6.4 (SD = 2.8, p ≤ 0.0001). After a mean follow-up of 13.4 months (SD = 14.1), six patients with recurrence underwent a new PSPR and five patients underwent colostomy, mainly because of incontinence, resulting in a recurrence rate of 20.4%. There were no complications after redo PSPR, and after a median of 10-month follow-up (range 6-37), there were no recurrences. CONCLUSIONS PSPR is a rather new surgical procedure for external rectal prolapse. Immediate complications are few and not serious. Although recurrences can be treated with a second PSPR, the operation may only be the best option for old and fragile patients with comorbidities and a short life expectancy.
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Affiliation(s)
- D Raahave
- Department of Surgery, North Zealand Hospital, Copenhagen University, 3400, Hillerød, Denmark.
| | - A K Jensen
- Section of Biostatistics, Institute of Public Health, Copenhagen University, Copenhagen, Denmark
| | - L Dammegaard
- Department of Surgery, North Zealand Hospital, Copenhagen University, 3400, Hillerød, Denmark
| | - I K Pedersen
- Department of Surgery, North Zealand Hospital, Copenhagen University, 3400, Hillerød, Denmark
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Guimerà-García J, Pieras-Ayala E, Burgués-Gasion JP, Ozonas-Moragues M, Tubau-Vidaña V, Piza-Reus P. Perineal approach for rectourethral fistulae after radical laparoscopic prostatectomy. Actas Urol Esp 2016; 40:119-23. [PMID: 26614434 DOI: 10.1016/j.acuro.2015.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 09/15/2015] [Accepted: 09/16/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To describe our experience with the perineal approach to treat rectourethral fistulae (RUF) after radical laparoscopic prostatectomy. MATERIALS AND METHODS We performed a retrospective study from 2012 to 2015 presenting 5 cases of RUF after radical laparoscopic prostatectomy. All cases required major abdominal surgery between the radical laparoscopic prostatectomy and the RUF treatment due to various complications. In no case was radiation therapy indicated prior to or after the repair. A perineal approach was performed in the 5 cases as the first option. One case required a second operation with a combined approach (abdominal and perineal) due to persistent fistulae. RESULTS After a minimum of 12 months of follow-up, 5 cases had resolved the RUF. Two patients presented urinary incontinence, and one patient had an anastomotic stricture that required internal urethrotomy. The other patients had no long-term complications. CONCLUSION The perineal approach provides a healthy surgical field in patients who undergo multiple operations, achieving high rates of resolution of the fistulae.
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Affiliation(s)
- J Guimerà-García
- Servicio de Urología, Hospital Universitario Son Espases, Palma de Mallorca, España.
| | - E Pieras-Ayala
- Servicio de Urología, Hospital Universitario Son Espases, Palma de Mallorca, España
| | - J P Burgués-Gasion
- Servicio de Urología, Hospital Universitario Son Espases, Palma de Mallorca, España
| | - M Ozonas-Moragues
- Servicio de Urología, Hospital Universitario Son Espases, Palma de Mallorca, España
| | - V Tubau-Vidaña
- Servicio de Urología, Hospital Universitario Son Espases, Palma de Mallorca, España
| | - P Piza-Reus
- Servicio de Urología, Hospital Universitario Son Espases, Palma de Mallorca, España
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