Robotic Simultaneous Repair of Rectovesical Fistula with Bladder Neck Contracture after Radical Prostatectomy: Step-by-Step Technique and Outcomes

Abstract The purpose of this study is to report our experience and outcomes using a novel robotic technique for the simultaneous repair of rectovesical fistula (RVF) with bladder neck contracture (BNC) after radical prostatectomy (RP). Between 2019 and 2021, four consecutive patients who underwent robotic-assisted simultaneous repair of RVF with concurrent BNC after RP were retrospectively reviewed. Baseline characteristics and perioperative outcomes were examined and reported. Complications were graded using the modified Clavien-Dindo classification system and the European Association of Urology Complication Panel Assessment and Recommendations. Four cases with a median age of 68.5 (63.3–72.3) years were treated. Interposition omentum flaps were used in all our cases. One case had perineal urethral mobilization 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 370 (291.3–453) minutes, 255 (175–262.5) mL, and 2.5 (2–3) days, respectively. Median Jackson-Pratt drains, Double-J stents and Foley catheter removal days were 6 (6–10), 38 (32–43), and 30 (27–41) days, respectively. No postoperative complications were reported. The median follow-up time was 13 (6–16) months, and no fistula recurrence was shown. Robotic-assisted repair could represent a feasible and effective approach for the simultaneous repair of RVF with concomitant BNC. Larger studies and treatment standardization are needed to assess the role of minimally invasive surgery in the simultaneous management of RVF with BNC after radical prostatectomy.