Modified York Mason technique for repair of iatrogenic

1. Journal reading
Sébastien Bergerat1 · François Rozet1 · Eric Barret1 · José Batista da Costa1 · Adalberto Castro1 · Paolo
Dell’oglio1 ·
Marc Galiano1 · Alexandre Ingels1 · Rafael Sanchez Salas1 · Xavier Cathelineau1
Presentator : Muhammad Reza
Supervisor : DR. dr. Dahril, Sp.U
DR. dr. Jufriady Ismy, Sp.U
dr. M. Ridha, Sp.U

3. Introduction
 Most recto-urinary fistulas are iatrogenic and
represent a rare but disastrous complication of
therapeutic interventions on the prostate, may
occur during surgical procedures, or after radiation
therapy.
 Recto-urinary fistulas (RUF) occur in 1–2% of
patients
 Numerous techniques have been reported for the
surgical repair of these fistulas

4. Materials and methods
Patient
• 30 consecutive patients for iatrogenic RUF between 1998 and
2017
• Follow up after 6–8 weeks, and then every 6 months for 1 year
Preoperative
• Preoperative urethral catheterization
• Diversion colostomy was not mandatory
• cystourethrography and digital rectal examination.
Statistic
• SPSS

5. Result
30 patients with RUF, 13 patient
after 1 repair
RUF : low, short direct path,
size 2-20 mm
Urine in stools in 90%,
Pneumaturia in 90%, and
Fecaluria in 37 %.
Successful healing :
80% : 24 patients of 30
97% : 29 patients of 30
100 % : 30 patiente of 30
Complication : intestinal bleeding 7%
Fecal incontinece 7%
Pararectal abscess 3%,
Perineal hematoma 3%
Blood loss p : 0,75
Operating time p : 0,26
Hospital stay p : 0,62

7. Discussion
 Several technique surgery fo RUF repair :
transabdominal, anterior sphincter-preserving
transperineal with tissue interposition,
anterior transanosphincteric, posterior transsacral,
Parks’ transanal endoluminal
 Aubrey York Mason described posterior
transsphincteric pathway

8.  This modification facilitates the rapid access to the
anterior rectal wall, and provides an excellent exposure
of the fistula
 The risk : fecal incontinece related to anal
spinchterectomy

11. Conclussion
 YM approach provides an excellent exposure
and a very low morbidity
 YM approach can be a preference in small,
uncomplicated and non-irradiated RUF
 theYM procedure can be combined to other
techniques of repair

12. TERIMA KASIH