Modified Transanosphincteric (York Mason) Repair of Nonradiated Rectourinary Fistulae: Patient-reported Fecal Continence Outcomes

Maxim J. McKibben, Joceline S. Fuchs, Alexander T. Rozanski, Jeremy M. Scott, Craig Olson, Farshid Araghizadeh, Allen F. Morey

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: To review our experience with the modified York Mason (MYM) procedure in the treatment of rectourinary fistulas (RUFs) and to assess fecal continence using patient-reported measures. Materials and Methods: A retrospective review was performed of patients who underwent MYM repair of nonradiated RUF with gluteal free fat graft from 2008 to 2016 at a single institution. Success was defined as resolution of the fistula without need for further surgery. The Cleveland Clinic-Florida Wexner Fecal Incontinence Score (CCFFIS) and the Patient Global Impression of Improvement (PGI-I) surveys were administered by phone. Results: Of 17 patients who underwent MYM repair with a mean age of 61.8 years old, the most common fistula etiologies were prostatectomy in 11 patients (65%), cryoablation in 2 patients (12%), and transanal tumor excision (12%). Three patients (18%) failed prior perineal repairs. The mean fistula size was 10.1 mm (range 2-25), the median operative time was 231 minutes (range 151-365), and the median length of stay was 2.0 days (range 1-13). At the median follow-up of 39.4 months, 16 of the 17 patients (94%) had successful primary closures. The condition of the 10 patients who responded to the phone survey was “much better” (median PGI-I score 2), with 89.5% mean improvement. The mean CCFFIS was 1.4 (range 0-5) on a scale of 0 (total continence) to 20 (complete incontinence). Two patients (20%) reported rare (<1 per month) fecal incontinence, and 2/10 (20%) reported frequent flatal incontinence, but none reported significant lifestyle change or sought further treatment for bowel symptoms. Conclusion: The MYM technique has a high success rate in the treatment of nonradiated RUF with negligible impact on fecal continence.

Original languageEnglish (US)
JournalUrology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Fistula
Fecal Incontinence
Cryosurgery
Operative Time
Prostatectomy
Life Style
Length of Stay
Therapeutics
Fats
Transplants

ASJC Scopus subject areas

  • Urology

Cite this

Modified Transanosphincteric (York Mason) Repair of Nonradiated Rectourinary Fistulae : Patient-reported Fecal Continence Outcomes. / McKibben, Maxim J.; Fuchs, Joceline S.; Rozanski, Alexander T.; Scott, Jeremy M.; Olson, Craig; Araghizadeh, Farshid; Morey, Allen F.

In: Urology, 01.01.2018.

Research output: Contribution to journalArticle

McKibben, Maxim J. ; Fuchs, Joceline S. ; Rozanski, Alexander T. ; Scott, Jeremy M. ; Olson, Craig ; Araghizadeh, Farshid ; Morey, Allen F. / Modified Transanosphincteric (York Mason) Repair of Nonradiated Rectourinary Fistulae : Patient-reported Fecal Continence Outcomes. In: Urology. 2018.
@article{0ef724e53ef64147bd421c416e588869,
title = "Modified Transanosphincteric (York Mason) Repair of Nonradiated Rectourinary Fistulae: Patient-reported Fecal Continence Outcomes",
abstract = "Objective: To review our experience with the modified York Mason (MYM) procedure in the treatment of rectourinary fistulas (RUFs) and to assess fecal continence using patient-reported measures. Materials and Methods: A retrospective review was performed of patients who underwent MYM repair of nonradiated RUF with gluteal free fat graft from 2008 to 2016 at a single institution. Success was defined as resolution of the fistula without need for further surgery. The Cleveland Clinic-Florida Wexner Fecal Incontinence Score (CCFFIS) and the Patient Global Impression of Improvement (PGI-I) surveys were administered by phone. Results: Of 17 patients who underwent MYM repair with a mean age of 61.8 years old, the most common fistula etiologies were prostatectomy in 11 patients (65{\%}), cryoablation in 2 patients (12{\%}), and transanal tumor excision (12{\%}). Three patients (18{\%}) failed prior perineal repairs. The mean fistula size was 10.1 mm (range 2-25), the median operative time was 231 minutes (range 151-365), and the median length of stay was 2.0 days (range 1-13). At the median follow-up of 39.4 months, 16 of the 17 patients (94{\%}) had successful primary closures. The condition of the 10 patients who responded to the phone survey was “much better” (median PGI-I score 2), with 89.5{\%} mean improvement. The mean CCFFIS was 1.4 (range 0-5) on a scale of 0 (total continence) to 20 (complete incontinence). Two patients (20{\%}) reported rare (<1 per month) fecal incontinence, and 2/10 (20{\%}) reported frequent flatal incontinence, but none reported significant lifestyle change or sought further treatment for bowel symptoms. Conclusion: The MYM technique has a high success rate in the treatment of nonradiated RUF with negligible impact on fecal continence.",
author = "McKibben, {Maxim J.} and Fuchs, {Joceline S.} and Rozanski, {Alexander T.} and Scott, {Jeremy M.} and Craig Olson and Farshid Araghizadeh and Morey, {Allen F.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.urology.2018.05.010",
language = "English (US)",
journal = "Urology",
issn = "0090-4295",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Modified Transanosphincteric (York Mason) Repair of Nonradiated Rectourinary Fistulae

T2 - Patient-reported Fecal Continence Outcomes

AU - McKibben, Maxim J.

AU - Fuchs, Joceline S.

AU - Rozanski, Alexander T.

AU - Scott, Jeremy M.

AU - Olson, Craig

AU - Araghizadeh, Farshid

AU - Morey, Allen F.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective: To review our experience with the modified York Mason (MYM) procedure in the treatment of rectourinary fistulas (RUFs) and to assess fecal continence using patient-reported measures. Materials and Methods: A retrospective review was performed of patients who underwent MYM repair of nonradiated RUF with gluteal free fat graft from 2008 to 2016 at a single institution. Success was defined as resolution of the fistula without need for further surgery. The Cleveland Clinic-Florida Wexner Fecal Incontinence Score (CCFFIS) and the Patient Global Impression of Improvement (PGI-I) surveys were administered by phone. Results: Of 17 patients who underwent MYM repair with a mean age of 61.8 years old, the most common fistula etiologies were prostatectomy in 11 patients (65%), cryoablation in 2 patients (12%), and transanal tumor excision (12%). Three patients (18%) failed prior perineal repairs. The mean fistula size was 10.1 mm (range 2-25), the median operative time was 231 minutes (range 151-365), and the median length of stay was 2.0 days (range 1-13). At the median follow-up of 39.4 months, 16 of the 17 patients (94%) had successful primary closures. The condition of the 10 patients who responded to the phone survey was “much better” (median PGI-I score 2), with 89.5% mean improvement. The mean CCFFIS was 1.4 (range 0-5) on a scale of 0 (total continence) to 20 (complete incontinence). Two patients (20%) reported rare (<1 per month) fecal incontinence, and 2/10 (20%) reported frequent flatal incontinence, but none reported significant lifestyle change or sought further treatment for bowel symptoms. Conclusion: The MYM technique has a high success rate in the treatment of nonradiated RUF with negligible impact on fecal continence.

AB - Objective: To review our experience with the modified York Mason (MYM) procedure in the treatment of rectourinary fistulas (RUFs) and to assess fecal continence using patient-reported measures. Materials and Methods: A retrospective review was performed of patients who underwent MYM repair of nonradiated RUF with gluteal free fat graft from 2008 to 2016 at a single institution. Success was defined as resolution of the fistula without need for further surgery. The Cleveland Clinic-Florida Wexner Fecal Incontinence Score (CCFFIS) and the Patient Global Impression of Improvement (PGI-I) surveys were administered by phone. Results: Of 17 patients who underwent MYM repair with a mean age of 61.8 years old, the most common fistula etiologies were prostatectomy in 11 patients (65%), cryoablation in 2 patients (12%), and transanal tumor excision (12%). Three patients (18%) failed prior perineal repairs. The mean fistula size was 10.1 mm (range 2-25), the median operative time was 231 minutes (range 151-365), and the median length of stay was 2.0 days (range 1-13). At the median follow-up of 39.4 months, 16 of the 17 patients (94%) had successful primary closures. The condition of the 10 patients who responded to the phone survey was “much better” (median PGI-I score 2), with 89.5% mean improvement. The mean CCFFIS was 1.4 (range 0-5) on a scale of 0 (total continence) to 20 (complete incontinence). Two patients (20%) reported rare (<1 per month) fecal incontinence, and 2/10 (20%) reported frequent flatal incontinence, but none reported significant lifestyle change or sought further treatment for bowel symptoms. Conclusion: The MYM technique has a high success rate in the treatment of nonradiated RUF with negligible impact on fecal continence.

UR - http://www.scopus.com/inward/record.url?scp=85049073242&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85049073242&partnerID=8YFLogxK

U2 - 10.1016/j.urology.2018.05.010

DO - 10.1016/j.urology.2018.05.010

M3 - Article

C2 - 29777788

AN - SCOPUS:85049073242

JO - Urology

JF - Urology

SN - 0090-4295

ER -