ENDOUROLOGY & LAPAROSCOPY

Laparoscopic rectovesical fistula repair
Sotelo R, Garcia A, Yaime H, Rodriguez E, Dubois R, Andrade RD, Carmona O, Finelli A
Section of Laparoscopic and Minimally Invasive Surgery, Department of Urology, “La Floresta” Medical Institute, Caracas, Venezuela
J Endourol. 2005; 19: 603-7

• Background and Purpose: Rectovesical fistula (RVF) is a rare complication of radical prostatectomy. A 62- year-old man with clinically localized prostate cancer underwent open radical prostatectomy that was complicated by rectal injury and subsequent RVF development. Conservative management failed, and the patient was referred for surgical correction.
• Technique: The operative steps consisted of (1) cystoscopy, (2) RVF catheterization, (3) ureteral catheterization, (4) five-port transperitoneal laparoscopic approach, (5) cystotomy, (6) opening of the fistulous tract, (7) dissection between the bladder and the rectum, (8) closure of the rectum, (9) interposition of omentum, (10) suprapubic cystostomy placement, (11) bladder closure, and (12) colostomy creation.
• Results: The operative time was 240 minutes. The hospital stay was 3 days. The urethral catheter was kept indwelling for 4 days. At 8 weeks postoperatively, the suprapubic tube was removed and the colostomy reversed. At 1-month follow-up, the patient remains free of fistula recurrence.
• Conclusion: Laparoscopic rectovesical fistula repair is feasible and represents an attractive alternative to the standard approaches.
  
  
• Editorial Comment
  Rectovesical fistula is a rare complication after radical prostatectomy but when it occurs, it is very frustrating for the patient and the surgeon involved. The authors describe a novel laparoscopic approach to a problem that traditionally has been managed with complex reconstructive open surgery. This manuscript demonstrates the universally well known attractive benefits of minimally surgery, including faster recovery and better cosmetic results.

Dr. Fernando J. Kim
Chief of Urology
Denver Health Medical Center
Denver, Colorado, USA