From the Research
Gas extending from the rectum along the left lateral aspect of the prostate gland is highly suggestive of a rectoprostatic fistula, a condition that requires prompt urological and colorectal surgical evaluation to prevent serious complications such as sepsis. This abnormal connection allows gas from the rectum to track into the prostatic tissue, and it typically results from inflammatory processes, prior surgery, radiation therapy, or malignancy. Patients may experience symptoms such as pneumaturia (air in urine), fecaluria (fecal material in urine), recurrent urinary tract infections, or passage of urine through the rectum.
Key Considerations
- Diagnosis is confirmed through imaging studies like CT scan with rectal contrast, MRI, or fistulography 1.
- Treatment depends on the underlying cause but generally requires surgical repair of the fistula, often with a diverting colostomy to allow healing.
- Antibiotics are typically prescribed to prevent or treat infection.
- The condition can lead to serious complications including sepsis if left untreated, emphasizing the need for prompt evaluation and management.
Management Approach
- Surgical repair is the mainstay of treatment, with the goal of closing the fistula and restoring normal anatomy and function.
- The choice of surgical technique depends on the location and complexity of the fistula, as well as the patient's overall health and medical history.
- In some cases, a diverting colostomy may be necessary to allow the fistula to heal, as noted in studies such as 2 and 3.
- The role of antibiotics in preventing or treating infection is crucial, as highlighted in the context of managing complications like prostatic abscesses 4.
Recent Evidence and Guidelines
- A recent study from 2023 discusses the current therapy of cryptoglandular anal fistula, which, although not directly related to rectoprostatic fistulas, underscores the importance of surgical treatment and the need for a tailored approach based on the fistula's characteristics and the patient's condition 5.
- Another study from 2018 provides insights into the incidence, risk factors, management, and complications of rectal injuries during radical prostatectomy, which can lead to rectoprostatic fistulas, emphasizing the need for careful surgical technique and postoperative care 1.