Outcome of a modified York Mason technique in men with iatrogenic urethrorectal fistula after radical prostatectomy

Mathieu Rouanne, Christophe Vaessen, Marc-Olivier Bitker, Emmanuel Chartier-Kastler, Morgan Rouprêt
Diseases of the Colon and Rectum 2011, 54 (8): 1008-13

BACKGROUND: Urethrorectal fistula formation is a rare but devastating complication after radical prostatectomy. Reconstructive surgery is usually required, and one surgical option is the York Mason procedure.

OBJECTIVE: We present our experience with a modified York Mason technique for the surgical management of urethrorectal fistula.

DESIGN: Retrospective review of medical records.

SETTING: Tertiary care university medical center.

PATIENTS: Consecutive male patients with urethrorectal fistula due to radical prostatectomy who underwent York Mason repair between 1998 and 2009.

INTERVENTION: All patients initially received both a urinary and a bowel diversion as the first step of the treatment. The second step consisted of a modification of the York Mason technique in which the approach began with a parasacrococcygeal incision extending from the coccyx to the anal verge.

MAIN OUTCOME MEASURES: All patients were seen 3, 6, and 12 months after surgery and yearly thereafter to assess the resolution of clinical functional disorders and the Wexner fecal incontinence score.

RESULTS: The study included 10 men with a mean age of 63.7 (range, 50-80) years who had urethrorectal fistula after open retropubic prostatectomy (n = 6) or after laparoscopic prostatectomy (n = 4). Confined prostate cancer (pT2) was found in 7 patients and extracapsular extension of the tumor (pT3) in 3 patients. Urethrorectal fistula was discovered because of fecaluria in 6 patients and pneumaturia in 6. The mean time from surgery to York Mason repair was 15 (range, 4-42) months. Five patients had each previously undergone 1 unsuccessful repair procedure. The mean operative time was 81 (range, 60-130) minutes and the mean hospital stay was 6 days. No fecal incontinence or anal stenosis developed after York Mason repair. No recurrence of urethrorectal fistula occurred during a mean follow-up of 24 (range, 18-38) months.

LIMITATIONS: Lack of objective fecal continence data.

CONCLUSIONS: : York Mason repair appears to be a safe and effective approach for management of urethrorectal fistula. The rates of fistula closure and symptom resolution are encouraging, and patients show rapid postoperative recovery with minimal morbidity. Thus, York Mason repair should always be considered for treatment of urethrorectal fistula after radical prostatectomy.

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