Abstract
The case of a 58-year-old man who underwent radical retropubic prostatectomy due to prostatic cancer is reported. During the surgery, the patient suffered damage of 1.5 cm in the anterior wall of the rectum, and so rectal restoration and ileostomy were performed. Cystography conducted one month after surgery showed that the rectum and bladder-urethra anastomotic region had formed a fistula, and rectourethral fistula was diagnosed. After conservative treatment for 3 months, the fistula remained and the patient was referred to our hospital for therapeutic treatment. In the surgery, the fistula was excised transperineally, then the fistula was completely covered with a right gracilis muscular flap by the laparoscopic approach. No complication was seen and the patient was discharged on the 8th postoperative day. After closure of the fistula was confirmed by cystography 4 months postoperatively, ileostomy closure was conducted in the same month. This case suggests that the transperineal approach with laparoscopy can be minimally invasive and can more certainly cover the fistula region with a gracilis muscular flap.
