Presentation Authors: Urszula Kowalik*, Brian Inouye, Stephanie Sexton, Brian Gilmore, Andrew Peterson, John Migaly, Christopher Mantyh, Durham, NC
Introduction: Iatrogenic recto-urethral fistulas are a rare but life altering. Conservative management often fails, leaving surgical repair as the treatment of choice, however the best choice for repair is debated with variable success rates reported in the literature. We looked at the success of the York-Mason utilized in a carefully selected patient population.
Methods: We performed a review of recto-urethral fistula repair outcomes after prostate and rectal cancer treatment as well as post-traumatic injuries at our facility from 2002-2017 utilizing a York-Mason repair. Per an algorithm we formally implemented in 2012, patients without a prior history of radiation and a fistula smaller than 3 cm were considered ideal candidates and offered this type of repair. All patients underwent urinary diversion with an SPT and bowel diversion with either a colostomy or ileostomy prior to or at the time of their repair. We assessed the rates of objective healing - with RUG and proctoscopy - as well as ostomy reversal rates.
Results: Over a 16-year period, of 65 patients undergoing surgery for recto-urethral fistula, 16 patients were repaired using a York-Mason procedure. Of these patients, all but one had objective confirmation of fistula healing and underwent reversal of their urinary and bowel diversion. The one failure in this series had a brachytherapy related fistula and underwent repair in 2006 prior to our firmly established criteria for using this procedure. Of the 10 patients for whom exact date of reversal is available, the average time to reversal was 5.3 months (median 4.5 months). There were no cases of fecal or gas incontinence.
Conclusions: The York-Mason technique can be an effective procedure for recto-urethral fistula repair in a select population. We feel that the best candidates for this procedure have a small fistula < 3cm and do not have a history of radiation therapy. We also feel that the sphincter-sparing modification that was adopted in 2014 has augmented preservation of sphincter function. Since we have employed strict criteria to select the appropriate candidates for this surgery, we have had 100% success with not only fistula healing, but also restoration of urinary and bowel continuity.