Therapeutic difficulties in vesicorectal fistula treatment using several techniques in one center

Introduction: Vesicorectal fistula (VRF) is a rare but devastating condition that may develop after surgery or radiotherapy. Many surgical methods to treat VRF have been described, but there is still no gold standard of VRF treatment. Aim: The aim of the study is to present our experience in the treatment of VRFs and analyze different surgical techniques applied in our center retrospectively. Material and methods: From June 2016 to June 2020, 7 patients (5 males and 2 females) aged 59–73 years (average 67.3 years) were treated for VRF in our center. The primary causes of VRFs were complications after laparoscopic radical prostatectomy (LRP), sigmoidectomy, laparotomy with removal of the tumour of the vaginal stump and anterior rectal resection and colostomy, Hartmann’s operation due to rectosigmoid carcinoma, radiotherapy, treatment of cervical cancer and transurethral resection of bladder tumor (TURBT). The patients were treated with one of the following methods: transvesical laparoscopic single-site surgery (T-LESS), transanal minimally invasive surgery (TAMIS), transurethral fulguration and radical cystectomy with the Bricker’s ileal conduit. Results and discussion: Five patients underwent T-LESS, 2 TAMIS, 1 transurethral fulguration and 1 radical cystectomy with the Bricker’s ileal conduit. The mean postoperative hospital stay was 4 days (range 2–8 days). The mean operative time was 139 minutes (range 100–285 minutes). Only 1 patient had a recurrence of a fistula. Conclusions: Surgical management of VRFs is obligatory to prevent possible complications. Currently, there is no gold standard for treatment of VRFs. Therefore, this condition requires further investigation.