Long-term patient-reported outcomes of open urorectal fistula repair after prostate cancer treatment.

Abstract

To evaluate long-term outcomes of open urorectal fistula (URF) repair, including URF recurrence, need for re-intervention, and patient-reported outcomes. This retrospective study included men undergoing open URF repair between 2014 and 2024. Data collected encompassed comorbidities, prostate cancer treatment history, prior URF interventions, and intraoperative details. Endpoints were: (i) URF recurrence-free survival, (ii) re-intervention-free survival (no further disease-related procedures), and (iii) validated patient-reported outcome measures (PROMs). Kaplan-Meier estimators were used for survival analyses; PROMs were scored according to standard protocols. A total of 29 patients underwent open URF repair. The median (interquartile range [IQR]) age was 68 (61-71) years, body mass index was 26 (23-28) kg/m², and the time from prostatectomy to URF repair was 10 (4-13) months. Five patients (17%) had prior pelvic radiotherapy; 13 (45%) underwent redo repairs. Presenting symptoms included rectal urine leakage (48%), pneumaturia (24%), recurrent infections (21%), dysuria (21%), and faecaluria (10%). Transperineal repair was performed in 26 patients (90%) and transabdominal repair in three (10%). The median (IQR) operating time was 90 (80-107) min. The median follow-up was 50 months for recurrence and 58 months for re-intervention. The 5-year URF recurrence-free and any disease-related re-intervention-free survival estimates were 96% and 75%, respectively. The median (IQR) six-item lower urinary tract symptoms score from the Urethral Stricture Surgery PROM was 4 (2-8), International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form sum score was 11 (6-15), Wexner faecal incontinence score was 3 (1-9), International Consultation on Incontinence Questionnaire-Satisfaction outcome score was 21 (18-23), and Decision Regret Scale score was 0 (0-10), indicating restored voiding function, moderate urinary incontinence, mild faecal incontinence, high patient satisfaction, and negligible decisional regret. Open URF repair achieves durable URF closure with favourable long-term outcomes, even in complex cases. Patient satisfaction is high, while moderate urinary incontinence persists in some, likely reflecting underlying disease. Voiding and faecal continence remain largely preserved.