Case - Combined endoscopic cautery and over-the-scope-clip closure of an acquired rectourethral fistula: A novel surgical repair technique.

Abstract

Introduction In 2012, prostate cancer was the most frequently diagnosed cancer among males in Canada and accounted for 23.4% of all new cancer cases diagnosed. The standard of care for localized prostate cancer is radical prostatectomy (RP). Other therapeutic interventions include radiotherapy (external beam radiotherapy [EBRT] or brachytherapy [BT]), androgen deprivation therapy, and high intensity focused ultrasound (HIFU). The adverse effects of prostate cancer treatments include, but are not limited to, urinary incontinence, erectile dysfunction, bladder neck contracture, urethral stricture, irradiation cystitis, proctitis, enteritis, and rarely rectourethral fistulas (RUFs). RUFs are uncommon, approximately less than 2% of patients are at risk of RUF following primary prostate cancer treatment (RP, EBRT, or BT). We present the first use of an endoscopic closure technique by using a combination of over-the-scope clip (OTSC) and electrocautery for RUF repair. We hypothesize that electrocautery of the fistula tract de-nudes/de-epithelializes the fistula tract. This subsequently creates superficial inflammation and promotes bridging scar formation enabling successful fistula closure. Furthermore, combining electrocautery of the fistula tract with an OTSC also allows the user to grab more tissue and utilize the significant compressive force of the OTSC.