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

Year: 2026

Type: article

Abstract: OBJECTIVES: To evaluate long-term outcomes of open urorectal fistula (URF) repair, including URF recurrence, need for re-intervention, and patient-reported outcomes. PATIENTS AND METHODS: 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. RESULTS: , 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. CONCLUSION: 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.

Source: British Journal of Urology

DOI: 10.1111/bju.70233