Rectourethral fistulas (RUF) are uncommon but serious complications that can significantly impact patient quality of life. Traditionally associated with prostate cancer therapies, RUFs have not been commonly linked to benign prostatic hyperplasia (BPH) treatments, particularly as these procedures have become less invasive. Rezum therapy, which treats BPH by delivering water vapor to reduce obstruction, is generally considered safe, with few and mild side effects. However, in rare instances, RUF can arise as a complication post-Rezum, requiring surgical intervention. This case study highlights the robotic approach to RUF repair following Rezum treatment, offering insights into procedure benefits and outcomes. In this case, the RUF repair was performed robotically alongside a simultaneous biopsy, which later revealed the presence of prostate cancer.
The robotic repair of RUF proved effective, allowing for a streamlined approach with reduced postoperative recovery time. The patient was discharged within three days post-surgery, and drainage tubes were removed within 2-3 weeks. At the one-month follow-up, a cystogram confirmed the patency of the anastomosis, allowing for the removal of the Foley catheter. The robotic technique offered precise control and minimized morbidity compared to traditional methods.
This study emphasizes the importance of recognizing potential complications, even with minimally invasive procedures like Rezum, as well as careful management strategies. Avoiding simultaneous invasive interventions and biopsies could help reduce the risk of severe complications. As the use of endourological treatments for BPH grows, healthcare providers should remain vigilant for rare but severe complications and be prepared with advanced robotic management options when needed.
