Introduction: Our case is that of a 62 year old male who underwent a robotic assisted laparoscopic prostatectomy complicated intraoperatively by a rectal injury. This injury was recognized at the time and repaired. However, he presented 1 week post op after catheter removal with leakage of urine per rectum. A CT scan confirmed a fistula to his rectum, thus an indwelling foley was placed and a diverting colostomy was performed by colorectal surgery. The patient presented to our clinic at 3 months post op to discuss definitive repair of his rectourethral fistula.
Methods: The attached video highlights our experience with a transanal approach to robotic repair of a rectourethral fistula.
Results: The patient was discharged home on post op day 1 with the catheter in place. At his 4 week follow up, his vcug was negative for leak and his catheter was removed. He follow up with colorectal surgery at 3 months, and barium enema at that time was negative for stricture or leak and he is currently awaiting ostomy reversal.
Conclusions: In this video, we demonstrate the feasibility of an incisionless transanal approach to repairing a rectourethral fistula using the multiport robot. Our approach is similar to a york-mason repair, but the use of the transanal port and robotic technology eliminate the need for any incision through the rectal sphincter.