Bladder Rectal Fistula after daVinci

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Carlos
Regular Member


Date Joined Nov 2009
Total Posts : 486
   Posted 4/20/2010 10:32 AM (GMT -6)   
A friend of mine developed a bladder rectal fistula soon after daVinci RP.  Now he's faced with two more surgeries.  One to repair the damage and another to reconnect the colorectal tissue a couple of months later.  Does anyone know how these come about?  His surgeon is relatively inexperienced and I have to believe this had something to do with it.  On the positive side,  his PSA, ED and continence are good. 
Carlos
 

Diagnosed 2/2008 at age 71, Gleason score 5+3=8, stage T1c, PSA 9.1. 
Robotic surgery 5/2008, nerves spared, All margins, SV and lymph nodes negative. 
Staged pT2c, Gleason score 5+3=8.  PSA <0.1 at 20 months, Jan. 4, 2010.


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4834
   Posted 4/20/2010 10:34 AM (GMT -6)   

For people like me that don't know:

In medicine, a fistula (pl. fistulas or fistulae) is an abnormal connection or passageway between two epithelium-lined organs or vessels that normally do not connect. It is generally a disease condition, but a fistula may be surgically created for therapeutic reasons.

http://en.wikipedia.org/wiki/Fistula


Age 55   - 5'11"   215lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
06/25/08 - Da Vinci robotic laparoscopy
05/14/09  - 4th Quarter PSA -> less then .01
11/20/09 - 18 Month PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 4/20/2010 4:46 PM (GMT -6)   
The prostate has to be cut and scraped off the wall of the rectum. Some men's are attached even worse than others. This can cause a weakness in the wall, which can cause the rectum to "bulge" out, or in. Some fistulas actually protrude into the bladder which is in the same approximate area.

We had a guy not too long ago who was farting out his penis because of a fistula. Think we got problems ?
Goodlife
 
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01
1 year psa (364 days) .01


142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6980
   Posted 4/20/2010 5:57 PM (GMT -6)   
A rectal fistula can be caused by problems as simple as a hard, dry stool at the end of a bout of constipation. The scratch / cut in the rectum gets infected, but tries to heal over, trapping the infection. As the rectal tissue heals over, the infection follows blood vessels and then pops out in another location. If that location were the bladder, things would be ugly.

I was lucky enough that it was just another part of the colon, and it could be repaired. Surgery and a few weeks not sitting straight got me over it. The entire condition was much more painful than my DaVinci experience.

I would be hesitant to blame the DaVinci surgeon, as all of the conditions to create the problem are present even if he does a good job, as others have described here earlier.

My past experiences are the reason for taking stool softeners even when I don't seem to need them. It is so much easier than surgery.

Carlos
Regular Member


Date Joined Nov 2009
Total Posts : 486
   Posted 4/20/2010 7:38 PM (GMT -6)   
Thanks very much for the replies.  I can't even begin to imagine how difficult this is for my friend.  I guess the best thing I can do is offer my support and not ask too many questions. 
 
Carlos

Diagnosed 2/2008 at age 71, Gleason score 5+3=8, stage T1c, PSA 9.1. 
Robotic surgery 5/2008, nerves spared, All margins, SV and lymph nodes negative. 
Staged pT2c, Gleason score 5+3=8.  PSA <0.1 at 20 months, Jan. 4, 2010.

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