Dr Angelo Gousse reported on the use of the York Mason trans-sphincteric, trans-rectal approach to recto-urethral fistulas. One of the most important steps of this technique is to identify and tag the sphincter of the rectum in order to preserve continence. Colostomy may not be necessary in non-radiated patients with a fistula that is less than 2 cm in size. For most patients with a history of radiation, he recommends using a perineal approach instead.
Dr Andrew Peterson finished the session by describing the role for supravesical diversion in this patient population. At Duke, the colovesical and urology departments have developed a multidisciplinary algorithm for patients with radiation-induced urinary fistulas. If the patient has a fistula that is less than two centimeters, they will use a perineal approach with a gracilis flap. If the fistula is greater than three centimeters, they use a pelvic exenteration and diversion.
Written By: Lisa Parrillo, MD, Genitourinary Reconstructive Surgery Fellow, University of Colorado
at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA