Precise treatment of pelvic fracture urethral injury associated with urethrorectal fistula.

OBJECTIVE: To evaluate the effect of a new strategy of transperineal anastomotic urethroplasty (TAU) with proximal transection in treating pelvic fracture urethral injury (PFUI) associated with urethrorectal fistula (URF). PATIENTS AND METHODS: A retrospective review of all patients treated by TAU with proximal transection and fistula repair for PFUI associated with URF was performed between August 2013 and July 2022. Information on demographics, peri-operative variables, and postoperative follow-up outcomes was collected. Successful surgery was defined as restoration of a uniform urethral calibre using flexible cystoscopy (third postoperative month) without strictures or leakage, with no further interventions required. Functional outcomes, including erectile function (assessed using the five-item International Index of Erectile Function) and urinary continence, were assessed. RESULTS: Forty patients diagnosed with PFUI associated with URF and treated by TAU with proximal transection and rectal fistula repair were enrolled. Six patients (15.0%) had a history of failed urethral reconstruction. The mean stenosis length and fistula diameter were 2.9 cm and 1.2 cm, respectively. All patients underwent faecal diversion before urethroplasty. After a median (range) follow-up of 45 (3-115) months, the final success rate was 90.0% (36/40). Postoperative complications included haematoma in three patients, epididymo-orchitis in three, wound infection in one, wound bleeding in one, delayed wound healing in three, and wound numbness in three. The overall incidence of postoperative erectile dysfunction reached 75.0%, with a median (range) score of 9 (0-19). Normal continence was achieved in 31 patients (77.5%). Occasional incontinence without the need for urinal pads occurred in eight patients, whereas one patient required urinal pads. CONCLUSIONS: Transperineal anastomotic urethroplasty with proximal transection is a precise and effective surgical strategy for treating PFUI associated with URF. This strategy ensures a high success rate and improves surgical efficiency.

Clinical value of normal saline injection for expansion of the anterior perirectal space during prostate cryoablation.

BACKGROUND: The objective of this study is to describe the technique and evaluate the clinical value of normal saline (NS) injection for expanding the anterior perirectal space during prostate cryoablation for prostate cancer (PCa) patients. METHODS: PCa patients who received cryoablation between August 2014 and December 2019 were enrolled, and the technique of NS injection was adopted. The complications were evaluated. The prostate-specific antigen (PSA) nadir and biochemical progression-free survival (bPFS) were measured in localized PCa patients who received cryoablation as the primary treatment. RESULTS: A total of 159 PCa patients were included. Among 147 patients with the data of anterior perirectal space, the median (interquartile range [IQR]) distance of estimated iceball edge beyond the prostatic capsule was 8.3 (7.0-10.0) mm. No cases of urethrorectal fistula were reported; 29 patients developed urinary retention and 25 patients presented scrotal edema. All complications below Clavien-Dindo grade IIIb disappeared within 7 weeks after surgery. Urinary incontinence was reported in 6 patients. Among localized PCa patients, the median (IQR) follow-up time was 56.5 (36.0-73.5) months. The estimated 5-year bPFS was 82.3% overall, 82.8% for low-to intermediate-risk PCa patients, and 82.1% for high-risk PCa patients. For 52 patients received cryoablation alone, the median (IQR) PSA nadir was 0.147 (0.027-0.381) ng/mL. CONCLUSIONS: The technique of NS injection for expanding the anterior perirectal space during cryoablation surgery could avoid urethrorectal fistula and might benefit localized PCa patients with lower PSA nadir and longer bPFS.

Penile Agenesis with Urethrorectal Fistula and Vesicoureteral Reflux.

Background Penile agenesis occurs in 1 in 30 million births. The cause of this anomaly is the failure of development of genital tubercle. Case Report: A 1-day-old neonate was born with complete penile agenesis. Imaging investigations showed an ectopic urethral insertion in the anterior wall of the rectum, and a grade 3 left vesicoureteral reflux. Conclusion: Penile agenesis is a complex genital abnormality. It can be associated with urinary malformations that should be systematically investigated.

[York-Mason procedure for urethrorectal fistula: A report of 10 cases].

OBJECTIVE: To evaluate the effect of the York-Mason procedure (posterior sagittal approach) in the treatment of urethrorectal fistula. METHODS: Ten 15－80 (mean 54) years old male patients with urethrorectal fistula were treated by the York-Mason procedure, 3 by anoplasty for congenital anal atresia, 5 by laparoscopic radical prostatectomy, and the other 2 by radical rectal cancer resection. All the cases were single fistula with a history of 3 months to 18 years. Enterostomy was performed in 6 of the cases before the York-Mason procedure. RESULTS: The York-Mason procedure lasted 90－130 (mean 104) minutes, with no perioperative complications. Nine of the cases were successfully repaired in the first surgery and 1 in the second. The patients were discharged after an average of 7 hospital days postoperatively and followed up for 6－90 months without recurrence. CONCLUSIONS: The York-Mason procedure is a reliable and effective option for the treatment of urethrorectal fistula, with the advantages low morbidity, short operation time and fast recovery.

Aphallia: a review to standardize management.

Congenital aphallia is a rare anomaly with little supporting literature and controversial management. The aim of this review is to assess the most recent literature with a focus on staged management of these cases. We performed a PubMed search of all English literature in the past 10 years using the term aphallia. Twenty-three articles were identified of which six were excluded. A further three papers meeting our criteria were found in the references to papers initially identified. We found that management can be staged in three phases: short, intermediate and long-term. We conclude that optimal short-term management centers on resuscitation and urinary diversion as necessary, intermediate-term management entails urethrorectal fistula division, urethrostomy and neophallus creation and long-term management results in successful neophalloplasty, urethroplasty, prosthetic implant and continued protection of the upper urinary tracts with a Mitrofanoff. All this within a multidisciplinary team ensuring shared decision-making with the patient and their family.

Prevention and treatment of rectal complications after ~(125)I brachytherapy for prostate cancer / 中国微创外科杂志

Objective To evaluate the prevention and treatment of rectal complications following 125I brachytherapy for prostate cancer. Methods A total of 90 patients with locally advanced prostate cancer was treated by transrectal ultrasound guided prostate 125I brachytherapy combined with maximal androgen blockage from November 2001 to June 2006. The patients were followed every 1～3 months postoperatively, and rectal complications was analyzed and treated. Results Eighty-nine patients were followed for 1～55 months (mean, 22 months). The incidences of rectal complications at grade Ⅰ, Ⅱ, Ⅲ, and Ⅳ were 11.2% (10/89), 6.7% (6/89), 0%, and 2.2% (2/89), respectively. Symptomatic therapy was conducted in 16 patients with grade Ⅰ or Ⅱ complications, which were symptomatically relieved 6 months later. The grade Ⅳ complications occurred in 2 patients, one of whom underwent repeated examinations and treatment for proctitis, and the other of whom was complicated with severe diabetes and received a laparocolostomy with cystostomy. Conclusions The optimal medical treatment for radiation proctitis is follow-up checkups and observations. To reduce the incidence of urethrorectal fistula, excessive examinations and treatment should be avoided. Accompanying diabetes should be treated promptly and actively.

A case of transsacral approach for traumatic urethrorectal fistula / 대한비뇨기과학회지

The causes of urethrorectal fistula are multiple such as trauma, open prostatectomy, radiation therapy, infection and congenital anomaly and so forth. In considering the injured area, length and the condition or periurethral tissue, numerous approaches have been advocated for the treatment of the traumatic urethrorectal fistula. Herein we report the experience of successful transsacral repair of traumatic urethrorectal fistula in a 14 year-old male patient 3 months after cystostomy and colostomy installed.