Name:
Rectourethral Fistula After Concomitant Prostate Biopsy and Rezūm Procedures
Description:
Rectourethral Fistula After Concomitant Prostate Biopsy and Rezūm Procedures
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/bdc30f45-65c5-4a42-b199-59102f2d92f0/videoscrubberimages/Scrubber_1.jpg?sv=2019-02-02&sr=c&sig=go6PSwRQo9JUrJOyyhmGsALasOoc%2BRD0fcTLFMEpCUM%3D&st=2026-03-09T19%3A12%3A57Z&se=2026-03-09T23%3A17%3A57Z&sp=r
Duration:
T00H05M01S
Embed URL:
https://stream.cadmore.media/player/bdc30f45-65c5-4a42-b199-59102f2d92f0
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/bdc30f45-65c5-4a42-b199-59102f2d92f0/730547206-FistulapostrezumconCorrecionesReviewersmp4.mp4?sv=2019-02-02&sr=c&sig=57gFa%2ByHG%2Bd6w3JQGEUOgHaDyIgrH2cPFh9ukSAQHeg%3D&st=2026-03-09T19%3A12%3A57Z&se=2026-03-09T21%3A17%3A57Z&sp=r
Upload Date:
2024-01-18T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
SPEAKER: We are presenting the first reported case of a rectal urethral fistula post-Rezum and its subsequent robotic management. Our patient is a 70-year-old smoker with a complex previous medical history, including metastatic neuroendocrine tumor of the lung, status post-resection and immunotherapy, as well as low grade noninvasive bladder cancer, status post-transurethral resection. He is currently in remission of both neoplasms.
SPEAKER: He first presented to an outside hospital with lower urinary tract symptoms and rising PSA levels from 8.8 to 11.4 in a three-month period. He underwent a simultaneous ultrasound-guided transperineal biopsy and Rezum procedure. The biopsy revealed prostate cancer, Gleason 7, 4+3. On post-operative day 20, the patient presented to the emergency department due to acute urinary retention.
SPEAKER: Hence, a Foley catheter was placed and later repositioned since the balloon had been inflated in the urethra. Two weeks later, at the time of Foley catheter removal, urine was observed to be leaking from the rectum. His provider decided to monitor without a Foley catheter. Due to persistent symptoms, a cystogram was obtained and suggestive of a rectal urethral fistula, thus bilateral ureteral stents were placed and internalized into a Foley catheter while a concurrent lower GI scope revealed an anterior wall defect in the rectum, confirming a rectal urethral fistula.
SPEAKER: Due to failure of conservative management, the patient was then referred to us. Upon review of his medical records, we noticed that a recent CT scan showing a thickened bladder wall with a possible lesion was demonstrated. Therefore we performed a cystoscopy where we observed a fistulous tract at the prostatic urethra near the apex as well as a superficially raised bladder lesion in the right anterior wall so we proceeded with a transurethral bladder tumor resection.
SPEAKER: Bladder mass pathology was negative for malignancy and allowed us to move forward with surgical management of fistula repair. The patient was taken to the operating room where he underwent a robotic-assisted salvage prostatectomy with rectal urethral fistula repair. A 5 French open-ended catheter was placed through the fistula to facilitate tract identification.
SPEAKER: We first performed a standard prostatectomy. Dissection of a Rezum-treated prostate was difficult due to challenges in identifying surgical planes and the friability of the tissue. And as we approached the apex of the prostate, we identified the catheter through the fistula tract into the rectum. The prostate was placed in an endo catch bag.
SPEAKER: We then focused our attention on fistula repair. We interposed the neurovascular bundles over the prior fistula site to prevent future refistulization.
SPEAKER: Finally, we performed a vesicoureteral anastomosis and bladder neck reconstruction in the standard fashion. The bladder was filled with saline to confirm a watertight anastomosis.
SPEAKER: And an air leak test with a flexible sigmoidoscope demonstrated rectal integrity. Total operative time was nearly 3 and 1/2 hours and EBL was 100 cc's. Final pathology was Gleason 4+3 with negative margins and no evidence of extraprostatic extension. The patient was discharged on postoperative day two. The JP drain was removed on post-operative day 19. At four weeks post-op, a cystogram was negative for extravasation and the Foley catheter was removed at.
SPEAKER: Six months post-op, the patient was feeling well, having good bowel movements, was continent, and voiding appropriately. To our knowledge, this is the first case of a urinary fistula as a complication of a Rezum procedure in the reported literature. The robotic management of this complication is feasible, safe, and effective. In summary, avoiding simultaneous biopsy and invasive treatments inside of unclear prostate pathology could prevent major complications.
SPEAKER:
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