Rare cases – Low rectocystic fistula after radical prostatectomy and radiation
History
A 72-year-old male patient who had undergone radical prostatectomy with an open method in 2006 and subsequently received radiation to the area. Later that year he underwent a second right nephrectomy.
In August 2019, he showed expulsion of intestinal contents during urination and at the same time urine from the anus. The magnetic resonance imaging diagnosed a wide communication (fistula) of the rectum with the bladder with a diameter of 1.2 cm. (purple line), at a distance of 3 cm from the entrance of the anus (green line), i.e. 1 cm above the sphincter.
Surgical Treatment of Orthocystic Fistula
This fistula, due to its very difficult position near the sphincter of the anus and the neck of the bladder and also because of the previous operation and radiation, is the most difficult enterocystic fistula to treat.
The solution that had been proposed to the patient by other surgeons was a permanent colostomy. This was the reason why he was referred to the Bowel and Anus Clinic, where we were able to restore the bladder and bowel with a specialized operation as described below.
The hole of the fistula as seen on the colonoscopy, through which we see the inside of the bladder. The opening is large enough to pass the endoscope from the bowel into the bladder.
The fistula hole as seen transanally during the operation. The rectal mucosa up to 1-2 cm above the fistula has already been removed
The photo shows the intravesical catheter (balloon) through the fistula hole.
Successful restoration of the bladder (suturing) and reconstruction of the intestine with elimination of the fistula with the Soave type pull-through technique.
Final image of the pull-through operation with the new bowel protruding from the anus.
Results
Checkup after one month with MRI and rectoscopy where the correction of the communication and elimination of the fistula is confirmed (green line).
Clinic of Intestinal and Anal Diseases
Operations of this type are highly specialized and are performed in very few centers internationally. The Intestinal and Anal Diseases Clinic comes to meet this very need for specialized surgical techniques for the intestine and anus in Greece.