V04-02: Simultaneous Repair of Rectovesical Fistula with Bladder Neck Contracture after Radical Prostatectomy. A Novel Robotic Technique

Aref S. Sayegh*, Laura C. Perez, Anibal La Riva, David G. Ortega, Luis G. Medina, Edward Forsyth, Ryan Powers, Christine Hsieh, Rene Sotelo, Los Angeles, CA

Introduction: Rectovesical Fistula (RVF) and Bladder Neck Contracture (BNC) represent uncommon complications following radical prostatectomy. The incidence reported is 1% and 0-17.5%, respectively. Different robotic surgical techniques have been reported for the individual repair of RVF and BNC after radical prostatectomy, but simultaneous repair remains a challenge. This video presents a step-by-step robotic surgical technique for simultaneous repair of RVF with BNC.

Methods: Four consecutive cases of RVF with concurrent BNC after radical prostatectomy were treated through a novel robotic transabdominal approach by a single surgeon. Surgical steps were performed as illustrated in the video. Perioperative and functional outcomes were examined and reported. Continuous variables were reported as median and quartiles, whereas categorical variables were presented as frequencies and percentages.

Results: Four cases with a median age of 70 (65-72) years were treated. Half of the patients had previous colostomy. One case had perineal urethral mobilization in order to reach healthy urethral margins and tension-free vesicourethral anastomosis. Surgeries were uneventful, with no intraoperative complications reported. Median operative time, estimated blood loss, and length of hospital stay were 304 (249-378) minutes, 200 (163-250) mL, and 4 (3-4) days, respectively. Median Foley catheter removal was 32 (28-43) days. Median follow-up time was 23 (12-54) weeks. No postoperative complications and fistula recurrence were reported. Successful repair criteria were met in all the patients.

Conclusions: Robotic-assisted laparoscopic repair represent a safe and effective approach for the simultaneous management of rectovesical fistula with bladder neck contracture.

Source of Funding: None.