Efficacy analysis of modified York-Mason procedure combined with human acellular dermal matrix for repair of recto-urinary fistula
Objective:To investigate the efficacy of modified York-Mason procedure combined with human a-cellular dermal matrix for repair of recto-urinary fistula.Methods:The clinical data of 8 patients in the Depart-ment of Urology of the First Affiliated Hospital of Xiamen University from September 2013 to September 2023 were analysed.The mean age was 65.3(56-76)years old,and the fistula sites were at the low rectum,with a mean diameter of 19(6-45)mm.All 8 patients underwent cystostomy and colostomy before repair.The repair surgery was performed in the prone folding knife position.The recto-urinary fistula was removed through the anus,and the urethra and the rectal wall were separated for fistula repair.Human acellular dermal matrix was used during the repair process.After surgery,the retention catheterization and anti-infection treatment were per-formed,and the cystostomy tube was retained.Urethral cystoscopy was reviewed 3 months after the operation,and the cystostomy tube was removed in the successful patients.The standard for successful repair was no anal leakage during urination or fistula found by the imaging examination.Results:Eight patients underwent 10 re-pairs,and the average operation time was 90(55-125)min.The median follow-up was 22(6 to 30)months af-ter the first repair.Seven cases(87.5％)were repaired successfully including 6 cases of once repair and 1 case of twice repairs.Two cases of repeated repairs were all through transanal route.Only 1 case failed,because the pa-tient had received preoperative external pelvic radiotherapy.Larger fistula and stiff surrounding tissues were found by urethral cystoscopy.Then,the bilateral ureteral skin stomas were performed,and the patient finally under-went urinary and fecal diversions.Conclusion:Modified York-Mason procedure combined with human acellular dermal matrix can repair recto-urinary fistula with less trauma and complications and be applied repeatedly.Its definite efficacy and high success rate are suitable for fistula patients with low site and without radiotherapy.
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