RECTO-URETHRAL FISTULA AFTER RADICAL PROSTATECTOMY: TREATMENT WITH AUTOLOGOUS ADIPOSE-DERIVED STEM CELLS AND CLOSURE OF RECTAL ORIFICE - A PURE TRANS-ANAL APPROACH.
Chiara Eberspacher*, Enrico Coletta, Francesco Leone Arcieri, Stefano Arcieri, Domenico Mascagni
"Sapienza" University of Rome, Rome, Italy
Introduction
Treatment of rectovescical or recto-urethral fistula can be very challenging for surgeons. The incidence, after prostatectomy, is low, between 0.12 and 9%, with a delayed onset in most cases. Urinary catheter diversion, nephrostomy and a temporary colostomy can usually assure healing success, but in some cases surgery is needed and the approach can be complicated with a high rate of recurrence or persistence. We present the case of a recto-urethral anal fistula treated with mesenchimal stem cells and closure of the rectal orifice.
Case presentation
A 63 YO patient presented to outpatient visit with rectourethral fistula, 6 months after onset following a radical prostatectomy. The fistula was diagnosed two days after radical prostatectomy; the patient underwent bilateral nephrostomy and colostomy due to the presence of a pelvic abscess. He later removed nephrostomies after the resolution of the sepsis. When he came to our observation after 6 months, with urinary catheter and colostomy, he showed persistence of the fistula. After an initial attempt to repair the fistula with an advancement rectal flap, we decided to use autologous adipose derived stem cells. During a 70 minute procedure, we performed liposuction and mesenchimal stem cells purification. Then in lithotomy position, after a partial closure of the internal rectal orifice, we infiltrated the liquid containing the concentrated cells all around the orifice. No complications arose at the end of the procedure. During the follow-up, after a negative cystography, removal of the catheter was performed. After 1 year of follow-up the patient is in good general conditions.
Discussion
Autologous mesenchimal stem cells is widely used in surgery with a large initial application, especially in orthopaedic surgery. The first applications in proctology were carried out for anal fistula in inflammatory bowel diseases, in association with drainage seton, with good success and without impairment of anal continence. The new systems for collection and purification of mesenchimal stem cells from autologous fat, have made the procedure easy to perform, without conservation problems. Literature describes an initial experience in the treatment of recto-urethral fistula with infiltration during cystoscopy, at the urethral orifice and the procedure mentioned is quite long. We have described a different approach, totally trans-anal and with easier application and infiltration. It is only a first attempt with chances for future application.
Conclusion
Application of mesenchimal stem cells can solve some challenging situations in the treatment of complex anal fistulae. We have described the first case of a rectourethral anal fistula successfully treated with infiltration of autologous mesenchimal stem cells.
Back to 2023 Posters