A 65-year-old patient was diagnosed with prostate adenocarcinoma Gleason 6/10 in both prostatic lobes (TNM stage 2003 T1c).
PSA at diagnosis was 9.43 ng/ml.
In January 2006, the patient underwent radical retorposcopy (pathological report: Prostate adenocarcinoma Gleason 6/10 pT2c with tumor-free margins).
During dissection of the posterior face of the prostate opening of 2 cm in the anterior face of the rectum.
Direct closure of the rectal wall with loose stitches.
No other intraoperative complications.
On the fifth postoperative day, the patient developed fever (37.6 oC), abdominal pain, urinary fistula, fecaluria and signs of peritonitis on physical examination.
Abdominal CT showed retrohepatic free fluid, so an urgent laparotomy was performed, visualizing fecal peritonitis secondary to perforation in the sigmoid and abundant urine and feces in the pelvis.
A new v-urethral suture was performed, with resection of the perforated sigmoid segment and discharge deformity.
After emergency surgery, the patient presents with sepsis, requiring admission to the ICU for respiratory support.
During the septic picture, the patient has a urinary fistula with abundant urine output through drainage and surgical wound infection.
After respiratory and hemodynamic stabilization, the patient was discharged from the ICU with permeable stenosis.
Clear urine.
Subsequently, the urinary fistula disappeared and fat necrosis in the distal third of the surgical wound was observed, observing the abdominal muscles as the bottom of the ulcer.
A contrast cystography was performed from the urethrovesical junction to the rectal ampulla in March 2006.
With the diagnosis of rectal fistula conservative treatment is indicated by vesical catheterization until resolution of surgical wound infection and closure by second intention.
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In October 2006, due to the persistence of the fistulous orifice, urethrorectal fistula closure and transanal mucosal advancement flap were performed.
A month after surgery cystography was performed without leakage of contrast outside the urinary tract, so the bladder catheter was removed.
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In March 2007, abdominal wall closure and ventral hernia repair with mesh were performed.
In June 2007 the patient presented a comfortable spontaneous voiding and normal deposition.
Absence of urinary incontinence.
Erectile dysfunction treated with phosphodiesterase inhibitors and PSA lower than 0.15 ng/ml.
