Abstract
Aim
To present surgical technique and results of combined laparoscopic and modified posterior
sagittal approach (PSAP) saving the external sphincter in the management of rectourethral
fistula.
Methods
The operation was started by a laparoscopic approach to dissect around the rectal
pouch and separate the rectal pouch from the upper urethra. The PSAP saving the external
sphincter was added to completely separate the rectal pouch from the urethra. The
fistula was divided and closed. The rectal pouch was then pulled through a tunnel
created at the center of the external sphincter and an anoplasty was performed.
Results
From September 2011 to September 2012, 19 patients were operated on using the same
technique. Mean age of patients was 4.0 ± 1.8 months. Rectourethral fistula was located in the prostatic urethra in 15 patients
and in the bulbar urethra in 4 patients. The mean operative time was 82 ± 13 min. There were no intraoperative complications. Postoperative perforation of the
posterior wall of the rectum happened in one patient and required a second laparoscopic
operation. Follow-up after closure of colostomy from 1 month to 7 months revealed all patients were able to pass stool spontaneously. All patients could
urinate easily. No urethral fistula or diverticulum was detected on voiding cysto-urethrography.
Conclusions
Combined laparoscopic and PSAP saving the external sphincter is the easier and more
physiologic approach to manage rectourethral fistula with fewer complications.
Key words
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Article info
Publication history
Accepted:
March 2,
2013
Received in revised form:
February 21,
2013
Received:
December 5,
2012
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
