Therapeutic difficulties in vesicorectal fistula treatment using several techniques in one center
Maciej Przudzik 1  
,   Maria Derkaczew 1  
,   Robert Hofman 1  
,   Marek Roslan 1  
More details
Hide details
Department of Urology, School of Medicine, Collegium Medicum,University of Warmia and Mazury in Olsztyn, Poland
Robert Hofman   

Department of Urology, School of Medicine, University of Warmia and Mazury in Olsztyn, Poland
Submission date: 2021-07-02
Final revision date: 2021-12-07
Acceptance date: 2021-12-08
Online publication date: 2021-12-30
Vesicorectal fistula (VRF) is a rare but devastating condition that may develop after surgery or radiotherapy. Many surgical methods to treat VRF have been described, but there is still no gold standard of VRF treatment.

The aim of the study is to present our experience in the treatment of VRFs and analyze different surgical techniques applied in our center retrospectively.

Material and methods:
From June 2016 to June 2020, 7 patients (5 males and 2 females) aged 59–73 years (average 67.3 years) were treated for VRF in our center. The primary causes of VRFs were complications after laparoscopic radical prostatectomy (LRP), sigmoidectomy, laparotomy with removal of the tumour of the vaginal stump and anterior rectal resection and colostomy, Hartmann’s operation due to rectosigmoid carcinoma, radiotherapy, treatment of cervical cancer and transurethral resection of bladder tumor (TURBT). The patients were treated with one of the following methods: transvesical laparoscopic single-site surgery (T-LESS), transanal minimally invasive surgery (TAMIS), transurethral fulguration and radical cystectomy with the Bricker’s ileal conduit.

Results and discussion:
Five patients underwent T-LESS, 2 TAMIS, 1 transurethral fulguration and 1 radical cystectomy with the Bricker’s ileal conduit. The mean postoperative hospital stay was 4 days (range 2–8 days). The mean operative time was 139 minutes (range 100–285 minutes). Only 1 patient had a recurrence of a fistula.

Surgical management of VRFs is obligatory to prevent possible complications. Currently, there is no gold standard for treatment of VRFs. Therefore, this condition requires further investigation.

Dr. Nejat Düzgüneş assisted with editing.
The authors declare that they do not receive any specific funding for this work.
The authors declare that they have no conflicts of interests.
King RM, Beart RW, Mcilrath DC. Colovesical and rectovesical fistulas. Arch Surg. 1982;117(5):680–683.
Kiyasu Y, Kano N. Huge rectovesical fistula due to long-term retention of a rectal foreign body: A case report and review of the literature. Int J Surg Case Rep. 2017;31:163–166.
Grüter AAJ, Van Oostendorp SE, Smits LJH, et al. Minimally invasive perineal redo surgery for rectovesical and rectovaginal fistulae: A case series. Int J Surg Case Rep. 2020;77:733–738.
Zhan T, Wang L, Li M, et al. A multidisciplinary clinical treatment of locally advanced rectal cancer complicated with rectovesical fistula: A case report. J Med Case Rep. 2012;6:1–5.
Yan S, Sun H, Li Z, Liu S, Han B. Conservative treatment of rectovesical fistula after leakage following laparoscopic radical resection of rectal cancer. J Int Med Res. 2020;48(4).
Naguib NN, Sharaf UI. Vesicorectal fistula, case report and review of literature. Curr Urol. 2009;2(4):211–213.
Mao Q, Luo J, Fang J, Jiang H. Management of radiation-induced rectovesical fistula in a woman using ileum. Medicine (Baltimore). 2017;96(46):e8553.
Roslan M, Borowik M, Przudzik M, Ćwikła J, Zadrożny D. Iatrogenic vesicorectal fistula: therapeutic challenges. Case reports and literature review [in Polish]. Nowa Med. 2020;27(2):42–48.
Kaouk JH, Haber GP, Goel RK, et al. Single-port laparoscopic surgery in urology: initial experience. Urology. 2008;71(1):3–6.
Roslan M, Przudzik M, Borowik M. Endoscopic intact removal of medium-size- or multiple bladder stones with the use of transvesical laparoendoscopic single-site surgery. World J Urol. 2019;37(2):373–378.
Watts A, Kocher NJ, Pauli E, Raman JD. Endoscopic Closure of a Large Rectovesical Fistula following Robotic Prostatectomy. J Endourol Case Reports. 2020;6(3):139–142.
Tobias-Machado M, Mattos PAL, Juliano CAB, da Costa RMM, Vaz Juliano R, Pompeo ACL. Transluminal approaches to vesicorectal fistula repair. Int Braz J Urol. 2014;40(2):283–284.
Crippa A, Dall’Oglio MF, Nesrallah LJ, Hasegawa E, Antunes AA, Srougi M. The York-Mason technique for recto-urethral fistulas. Clinics. 2007;62(6):699–704.
Roslan M, Jarzemski P, Markuszewski M, Listopadzki S, Jarzemski M. V11-09 Transvesical laparoendoscopic single-site surgery (T-Less) for post prostatectomy vesicorectal fistula repair: first clinical experience. J Urol. 2014;191(4S):e952–e953.
Sowa P, Rutkowska-Talipska J, Sulkowska U, Rutkowski K, Rutkowski R. Ionizing and non-ionizing electromagnetic radiation in modern medicine. Pol Ann Med. 2012;19(2):134–138.
Kanehira E, Tanida T, Kamei A, Nakagi M, Iwasaki M, Shimizu H. Transanal endoscopic microsurgery for surgical repair of rectovesical fistula following radical prostatectomy. Surg Endosc. 2015;29(4):851–855.
Sotelo R, Garcia A, Yaime H, et al. Laparoscopic rectovesical fistula repair. J Endourol. 2005;19(6):603–606.