Surgical treatment of radiogenic prostate-urethra-rectum fistula

Five patients with postirradiation prostatic urethrorectal fistules after treatment of localized carcinoma of the prostate by external beam and interstitial implantation with 125I seeds were treated by two different methods. Previous defunctioning colostomy and suprapubic tube diversion alone failed to close the lesion. Three patients underwent anterior rectal resection and restoration by deep colo-anal anastomosis. Two more patients were treated by anterior "pull-through-resection" with mucosectomy of the distal rectal stump and colo-anal sleeve anastomosis as described by Parks. In addition, omentum was used to fill the pelvis. This operative technique is favoured due to improved results.