Robotic Simultaneous Repair of Rectovesical Fistula with Vesicourethral Anastomotic Stricture after Radical Prostatectomy: Step-by-Step Technique and Outcomes.

Feb 27, 2023

Experts: Aref S Sayegh,Anibal La Riva,Laura C Perez,Luis G Medina,Jaime Poncel,David G Ortega,Maria A Lizana,Edward Forsyth,Rene Sotelo

To report our experience and outcomes using a novel robotic technique for the simultaneous repair of rectovesical fistula (RVF) with vesicourethral anastomotic stricture (VUAS) after radical prostatectomy (RP).
Between 2019 and 2021, four consecutive patients who underwent robotic-assisted simultaneous repair of RVF with concurrent VUAS after RP were retrospectively reviewed. Baseline characteristics and perioperative outcomes were examined and reported. Complications were graded using the modified Clavien-Dindo classification system and the European Association of Urology Complications Panel Assessment and Recommendations.
Four cases with a median age of 68.5 (63.3-72.3) years were treated. Interposition omentum flaps were used in all our cases. One case had perineal urethral mobilization to reach healthy urethral margins and tension-free vesicourethral anastomosis. Surgeries were uneventful, with no intraoperative complications reported. Median operative time, estimated blood loss, and length of hospital stay were 370 (291.3 – 453) minutes, 255 (175 – 262.5) mL, and 2.5 (2 – 3) days, respectively. Median Jackson-Pratt drains, Double-J stents and Foley catheter removal days were 6 (6 – 10), 38 (32 – 43), and 30 (27 – 41) days, respectively. No postoperative complications were reported. The median follow-up time was 16.25 (12 – 26) months, and no fistula recurrence was shown.
Robotic-assisted laparoscopic repair could represent an effective approach for the simultaneous repair of RVF with concomitant VUAS. More studies and management standardization are needed to assess the role of the robotic platform in the simultaneous repair of RVF with VUAS after radical prostatectomy.

Copyright © 2023. Published by Elsevier Inc.

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ABOUT THE EXPERTS

Aref S Sayegh,Anibal La Riva,Laura C Perez,Luis G Medina,Jaime Poncel,David G Ortega,Maria A Lizana,Edward Forsyth,Rene Sotelo

Aref S Sayegh

Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.

Anibal La Riva

Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.

Laura C Perez

Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Luis G Medina

Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.

Jaime Poncel

Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.

David G Ortega

Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.

Maria A Lizana

Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.

Edward Forsyth

Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.

Rene Sotelo

Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. Electronic address: rene.sotelo@med.usc.edu.