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Robotic Management of Rectourethral Fistulas After Focal Treatment for Prostate Cancer.

ABSTRACT: OBJECTIVE:To describe our management strategy for rectourethral fistula (RUF) after focal treatment for prostate cancer (PCa) using 2 cases as an example. Almost 50% of RUFs are associated with energy treatment modalities for PCa. The adjacent damage to healthy tissue along with limited pliability of it makes the success of the repair troublesome. There is no standardized approach for these scenarios. MATERIALS AND METHODS:For case 1, an 83-year-old man underwent cryotherapy for PCa. On postoperative day 14, he presented with urine per rectum. Cystoscopy confirmed the presence of an RUF. Urinary and fecal diversions were unsuccessful. Three months later, robotic surgical repair was performed. For case 2, an 85-year-old man underwent salvage therapy for PCa with high-intensity focused ultrasound after previous treatment with external beam radiation therapy. Two months postoperatively, he presented with urine per rectum. A computed tomography scan confirmed the presence of an RUF. Robotic surgical repair was subsequently performed. RESULTS:Both patients underwent robotic-assisted RUF repair, including salvage prostatectomy , rectal defect closure, and omental flap placement. In the first case, healthy urethra was present after the salvage prostatectomy, and the next step was completion of a vesicourethral anastomosis. In the second case, the next step was closure of the bladder neck and suprapubic tube placement due to the extensive tissue destruction the residual urethra. Success was confirmed with imaging studies and no reported symptoms at 9 and 4 months, respectively. CONCLUSION:The robotic system is useful for the treatment of a complicated RUF. The optimal reconstruction strategy depends on the ability to reach the distal urethra, the patients' characteristics, and preferences.

SUBMITTER: Medina LG

PROVIDER: S-EPMC9235520 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:The incidence of localised prostate cancer is increasing worldwide. In light of recent evidence, current, radical, whole-gland treatments for organ-confined disease have being questioned with respect to their side effects, cancer control, and cost. Focal therapy may be an effective alternative strategy.To systematically review the existing literature on baseline characteristics of the target population; preoperative evaluation to localise disease; and perioperative, functional, and disease control outcomes following focal therapy.Medline (through PubMed), Embase, Web of Science, and Cochrane Review databases were searched from inception to 31 October 2012. In addition, registered but not yet published trials were retrieved. Studies evaluating tissue-preserving therapies in men with biopsy-proven prostate cancer in the primary or salvage setting were included.A total of 2350 cases were treated to date across 30 studies. Most studies were retrospective with variable standards of reporting, although there was an increasing number of prospective registered trials. Focal therapy was mainly delivered to men with low and intermediate disease, although some high-risk cases were treated that had known, unilateral, significant cancer. In most of the cases, biopsy findings were correlated to specific preoperative imaging, such as multiparametric magnetic resonance imaging or Doppler ultrasound to determine eligibility. Follow-up varied between 0 and 11.1 yr. In treatment-naïve prostates, pad-free continence ranged from 95% to 100%, erectile function ranged from 54% to 100%, and absence of clinically significant cancer ranged from 83% to 100%. In focal salvage cases for radiotherapy failure, the same outcomes were achieved in 87.2-100%, 29-40%, and 92% of cases, respectively. Biochemical disease-free survival was reported using a number of definitions that were not validated in the focal-therapy setting.Our systematic review highlights that, when focal therapy is delivered with intention to treat, the perioperative, functional, and disease control outcomes are encouraging within a short- to medium-term follow-up. Focal therapy is a strategy by which the overtreatment burden of the current prostate cancer pathway could be reduced, but robust comparative effectiveness studies are now required.

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Robotic Management of Rectourethral Fistulas After Focal Treatment for Prostate Cancer.

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