Login to Access Video or Poster Abstract: MP36-11
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Introduction

Rectourethral fistulae (RUF) is a debilitating diagnosis and complex surgical dilemma. There are few data about quality of life (QOL) of men after RUF repair. QOL after RUF repair was analyzed.

Methods

Patients who underwent rectal sphincter-sparing transperineal RUF repair between 1/2009 and 5/2016 were assessed. An interposition muscle flap was utilized for all radiated/ablative RUFs and select non-radiated repairs. Patient data were abstracted via retrospective chart review. Patients were contacted by telephone to inquire about QOL following repair.

Results

21 men underwent RUF repair (table). Six patients had a complication within 30 days (wound infection (3), GI bleed (1), pelvic abscess (1), renal insufficiency (1)). A successful surgical outcome was obtained in 20/21 patients. Ten patients subsequently underwent placement of an artificial urinary sphincter, of which 2 required explantation/revision. _x000D_ _x000D_ At the time of updated followup (mean 45.6 ± 27.1 months), 15 patients were contacted. Two had died of unrelated causes. 53% of patients reported perineal pain (mean 2.1 ± 1.3; 10-point scale). 43% reported residual problems related to the gracilis flap (one each with numbness, weakness, limited groin mobility, difficulty walking/climbing stairs, occasional leg cramping, and leg swelling). 80% of patients reported urinary incontinence, the majority with occasional mild leakage. Two patients reported fecal incontinence._x000D_ _x000D_ 21% of patients were unable to do the things they wanted in their daily lives due to the surgery. 80% reported the surgery led to a positive change in their lives (mean satisfaction 3.5 ± 0.7, 4-point scale). 87% of patients would undergo surgery again, and 80% would recommend it to others. Nine patients reported they would have done things differently: 4 - sought different treatment/provider for RUF-inciting medical condition, 3 - RUF repair sooner, 2 - see a reconstructive specialist in lieu of local repair, 1 - request bilateral over unilateral gracilis flap. None would have opted for complete urinary diversion.

Conclusions

RUF repair leads to patient satisfaction and improvement in QOL, despite possible residual issues such as perineal pain and urinary incontinence. Definitive RUF repair should be offered to radiated and non-radiated patients who are suitable operative candidates.

Funding

none