York-Mason Repair of a Rectourethral Fistula in a Hostile Abdomen: A Case Report.

Rectourethral fistula is an uncommon but complex complication that may occur after prostate surgery and often requires individualized surgical management. The York-Mason transsphincteric approach represents an option for selected patients, particularly when previous abdominal procedures make conventional approaches challenging. This article describes the treatment of a rectourethral fistula using the York-Mason transsphincteric repair technique. The different surgical stages of this technique will be detailed, as an alternative to the management of rectus vesical fistula with hostile abdomen due to multiple surgical events. We present a case of rectourethral fistula as a complication of radical prostatectomy in a patient with multiple previous abdominal surgeries, for which a transrectal-transsphincteric approach with the York-Mason technique was used, with satisfactory evolution and without complications during the postoperative period and with short-term follow-up. A difficult case is shown in the management of rectal-urinary fistula with multiple abdominal surgeries, for which an alternative technique to the abdominal approach is performed with satisfactory results maintaining fecal continence and without postoperative complications. For patients with multiple surgical events where lysis of adhesions by sharp/blunt dissection could cause preventable organic damage, an alternative access to the conventional one is necessary to perform fistula repair. This technique has the advantage of offering rapid exposure with a large working space and low morbidity. Careful repair of the anal sphincter muscle groups in this technique will allow complete continence.