Radiological leak after Urorectal Fistula (URF) repair – Success or Failure?
BAUS ePoster online library. Bugeja S. 06/23/21; 319044; p13-6
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Simon Bugeja
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Abstract
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Introduction
This study evaluates the clinical significance of radiological leaks on pericatheter urethrogram after URF repair as a predictor of surgical success or failure.
Patients/Methods
138 URF repairs, mostly complicating prostate or rectal cancer treatment, were performed between January2006 and June2020 in a single reconstructive urology unit. Data were available on 113 for analysis.
Results
71 cases(63%) were performed transperineally(TP) with a gracilis flap in 27(38%). 42(37%) required additional abdominal exposure. 60(54%) were in irradiated patients. 20(18%) were redo procedures.
All had a pericatheter urethrogram at a mean 31days (range21-70d) post-op. 43(38%) showed no leak and the catheter removed. 30(27%) demonstrated contrast tracking directly into the rectum or onto the perineum. Only 4 of these healed by conservative management. The other 26 recurred.
In a further 40(35%), contrast leaked into a blind-ending track(n=24) or contained cavity(n=16). A second urethrogram was performed on average 24 days later(range7-93d). In 19, the leak was no longer evident and the catheter removed. The remaining 21 had a third urethrogram at a mean 32 days later(range 13-91d) and in 14 the leak had resolved. The rest(n=7) had their catheters removed on average 111 days post-op (range88-180d). Of all 40 patients with a contained leak on initial urethrogram managed conservatively, only 3 fistulae recurred after catheter removal; all after abdomino-perineal repairs in irradiated patients.
Conclusions
Radiological leak from the urinary side into a contained cavity or blind-ending track after URF repair is relatively common. Usually this can be managed successfully conservatively without compromising the final outcome.
This study evaluates the clinical significance of radiological leaks on pericatheter urethrogram after URF repair as a predictor of surgical success or failure.
Patients/Methods
138 URF repairs, mostly complicating prostate or rectal cancer treatment, were performed between January2006 and June2020 in a single reconstructive urology unit. Data were available on 113 for analysis.
Results
71 cases(63%) were performed transperineally(TP) with a gracilis flap in 27(38%). 42(37%) required additional abdominal exposure. 60(54%) were in irradiated patients. 20(18%) were redo procedures.
All had a pericatheter urethrogram at a mean 31days (range21-70d) post-op. 43(38%) showed no leak and the catheter removed. 30(27%) demonstrated contrast tracking directly into the rectum or onto the perineum. Only 4 of these healed by conservative management. The other 26 recurred.
In a further 40(35%), contrast leaked into a blind-ending track(n=24) or contained cavity(n=16). A second urethrogram was performed on average 24 days later(range7-93d). In 19, the leak was no longer evident and the catheter removed. The remaining 21 had a third urethrogram at a mean 32 days later(range 13-91d) and in 14 the leak had resolved. The rest(n=7) had their catheters removed on average 111 days post-op (range88-180d). Of all 40 patients with a contained leak on initial urethrogram managed conservatively, only 3 fistulae recurred after catheter removal; all after abdomino-perineal repairs in irradiated patients.
Conclusions
Radiological leak from the urinary side into a contained cavity or blind-ending track after URF repair is relatively common. Usually this can be managed successfully conservatively without compromising the final outcome.
Introduction
This study evaluates the clinical significance of radiological leaks on pericatheter urethrogram after URF repair as a predictor of surgical success or failure.
Patients/Methods
138 URF repairs, mostly complicating prostate or rectal cancer treatment, were performed between January2006 and June2020 in a single reconstructive urology unit. Data were available on 113 for analysis.
Results
71 cases(63%) were performed transperineally(TP) with a gracilis flap in 27(38%). 42(37%) required additional abdominal exposure. 60(54%) were in irradiated patients. 20(18%) were redo procedures.
All had a pericatheter urethrogram at a mean 31days (range21-70d) post-op. 43(38%) showed no leak and the catheter removed. 30(27%) demonstrated contrast tracking directly into the rectum or onto the perineum. Only 4 of these healed by conservative management. The other 26 recurred.
In a further 40(35%), contrast leaked into a blind-ending track(n=24) or contained cavity(n=16). A second urethrogram was performed on average 24 days later(range7-93d). In 19, the leak was no longer evident and the catheter removed. The remaining 21 had a third urethrogram at a mean 32 days later(range 13-91d) and in 14 the leak had resolved. The rest(n=7) had their catheters removed on average 111 days post-op (range88-180d). Of all 40 patients with a contained leak on initial urethrogram managed conservatively, only 3 fistulae recurred after catheter removal; all after abdomino-perineal repairs in irradiated patients.
Conclusions
Radiological leak from the urinary side into a contained cavity or blind-ending track after URF repair is relatively common. Usually this can be managed successfully conservatively without compromising the final outcome.
This study evaluates the clinical significance of radiological leaks on pericatheter urethrogram after URF repair as a predictor of surgical success or failure.
Patients/Methods
138 URF repairs, mostly complicating prostate or rectal cancer treatment, were performed between January2006 and June2020 in a single reconstructive urology unit. Data were available on 113 for analysis.
Results
71 cases(63%) were performed transperineally(TP) with a gracilis flap in 27(38%). 42(37%) required additional abdominal exposure. 60(54%) were in irradiated patients. 20(18%) were redo procedures.
All had a pericatheter urethrogram at a mean 31days (range21-70d) post-op. 43(38%) showed no leak and the catheter removed. 30(27%) demonstrated contrast tracking directly into the rectum or onto the perineum. Only 4 of these healed by conservative management. The other 26 recurred.
In a further 40(35%), contrast leaked into a blind-ending track(n=24) or contained cavity(n=16). A second urethrogram was performed on average 24 days later(range7-93d). In 19, the leak was no longer evident and the catheter removed. The remaining 21 had a third urethrogram at a mean 32 days later(range 13-91d) and in 14 the leak had resolved. The rest(n=7) had their catheters removed on average 111 days post-op (range88-180d). Of all 40 patients with a contained leak on initial urethrogram managed conservatively, only 3 fistulae recurred after catheter removal; all after abdomino-perineal repairs in irradiated patients.
Conclusions
Radiological leak from the urinary side into a contained cavity or blind-ending track after URF repair is relatively common. Usually this can be managed successfully conservatively without compromising the final outcome.
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