ABSTRACT
AIM: The results of repair of recto-urethral fistulae (RUF) are presented using a bulbocavernosus muscle graft. METHOD: Prospectively collected data were reviewed on 11 patients with RUF operated on between 2003 and 2011. Of these, six were treated by a bulbocavernosus flap. Two RUF had occurred after prostatectomy, three after prostatectomy and radiotherapy and one after perineal trauma; all had a urinary diversion. RESULTS: Closure of the fistula was achieved in all patients and was maintained for the duration of the period of follow up (mean ± SD = 43.5 ± 24.7 months; range, 8-80 months) There were no complications. CONCLUSION: This new technique for the repair of RUF is safe and effective, especially in patients with complex postradiation RUF.
Subject(s)
Prostatectomy/adverse effects , Prostatic Neoplasms/complications , Rectal Fistula/surgery , Ureter/surgery , Urethral Diseases/surgery , Urinary Diversion/methods , Urinary Fistula/surgery , Adult , Aged , Follow-Up Studies , Humans , Male , Middle Aged , Perineum/surgery , Prospective Studies , Prostatic Neoplasms/surgery , Rectal Fistula/etiology , Surgical Flaps , Treatment Outcome , Urethral Diseases/etiology , Urinary Fistula/etiologyABSTRACT
AIM: The outcome of the internal Delorme's procedure (IDP) for obstructed defaecation was assessed. METHOD: From October 2001 to March 2009, 167 patients with obstructed defaecation associated with rectal intussusception were operated on. Patients were selected on the basis of validated constipation and continence scores, clinical examination and defaecography. Seventy-six patients were treated by the IDP alone and 91 patients were treated by the IDP with a levatorplasty. Before surgery and after a mean ± SD follow up of 3.0 ± 1.5 years, patients were assessed using the Cleveland Clinic Incontinence and Constipation Score (CCIS and CCCS), the Obstructed Defecation Score (ODS), faecal urgency and the Patient Assessment of Constipation Quality of Life (PAC-QoL) questionnaire. RESULTS: Seventeen (10.2%) patients developed a postoperative complication including fissure-in-ano (4.2%), proctalgia (3.0%), suture-line dehiscence with stenosis (1.8%) and Clostridium difficile colitis (1.2%). Faecal urgency changed from 22% to 17.6% (P = 0.754). Tenesmus fell from 53.9% to 17.1% (P < 0.001). The CCCS and the ODS fell by 50% or more in 82.6% and 73.7% of the patients, respectively. The CCIS did not worsen significantly in patients who remained incontinent, and 45.7% of the previously incontinent patients regained normal continence. The CCCS decreased from 11 to 3 (P < 0.001) in the patients treated by the IDP and from 12 to 3 (P < 0.001) in the patients treated by the IDP with levatorplasty. The overall recurrence rate was 5.4%. The PAC-QoL showed a reduction of anxiety/depression and of physical and psychological discomfort (P < 0.001). CONCLUSION: The IDP is an effective and safe option for rectal outlet obstruction caused by rectal intussusception with excellent function and patient satisfaction.