2023 Volume 36 Issue 2 Pages 296-303
A 64-year-old man underwent robot-assisted radical prostatectomy for prostate cancer, but rectal injury was observed intraoperatively. After the removal of the prostate, robot-assisted suture closure was performed. The patient was instructed to fast for 1 week after the operation, after which laxatives were administered along with meals. The urethral catheter was removed on postoperative Day 9. The patient was discharged on postoperative Day 15. Diarrhea was observed on postoperative Day 21. On postoperative Day 26, abdominal computed tomography revealed an accumulation of fluid in the rectum, and cystourethrography showed a leak at the urethral anastomosis and contrast medium leakage into the rectum. Accordingly, the patient was diagnosed with a urethrorectal fistula within 4 weeks after surgery and on the 5th day after the occurrence of urinary diarrhea, which indicated relatively early detection. Thus, it was decided that natural closure could be expected with long-term catheterization for 3 months. Urethrography at 3 months revealed no leakage from the urethra-bladder anastomosis, and the urethrorectal fistula was considered closed. Therefore, the urethral catheter was removed. Approximately 1 year later, no recurrence of urethrorectal fistula has been observed.
