Apropos use of biological mesh in trans-anal treatment for recurrent recto-urethral fistula
Apropos use of biological mesh in trans‑anal treatment for recurrent recto‑urethral fistula
Deepak Batura 0
0 Department of Urology, London North West Healthcare NHS Trust , Watford Road, Harrow, London HA1 3UJ , UK
1 Deepak Batura
Vol.:(011233456789)
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Editor,
Moretto et al. are to be congratulated on their novel and
innovative method of repair of post-radical prostatectomy
recto-urethral fistulas, described in their paper: Use
of biological mesh in trans-anal treatment for recurrent
recto-urethral fistula [
1
]. A difficult condition to treat with frequent
recurrence, their minimally invasive method should hold
great promise.
However, the paper does raise a few queries about their
technique and outcomes. As these fistulas are clean
contaminated at best, and most likely infected at worst, it is
surprising that the authors relied only upon 6 days of ciprofloxacin
prophylaxis to prevent mesh infection. For instance, they do
not mention whether any enteric preparation or mechanical
bowel cleaning was employed beforehand. Enteric
preparation of some sort is a standard recommendation for anorectal
surgery [
2
].
The authors note no recurrence or complications over a
median follow-up of nearly 3 years. However, the literature
mentions a high rate of recurrences and infective
complications (sepsis, suppuration, or abscesses) following the use of
such devices in anorectal conditions [
3, 4
]. It is not
unreasonable to expect some of these complications or
recurrences when the plug is being used in a recto-urethral repair
as well. Therefore, it becomes necessary to know whether
any bacteriological studies were carried out during
followup. Certainly, it might be worth considering whether a study
Compliance with ethical standards
1. Moretto G , Casaril A , Inama M ( 2017 ) Use of biological mesh in trans-anal treatment for recurrent recto-urethral fistula . Int Urol Nephrol. doi:10.1007/s11255-017-1652-5
2. Mangram AJ , Horan TC , Pearson ML , Silver LC , Jarvis WR ( 1999 ) Guideline for Prevention of Surgical Site Infection , 1999 . Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee . Am J Infect Control 27 ( 2 ): 97 - 132
3. Garg P , Song J , Bhatia A , Kalia H , Menon GR ( 2010 ) The efficacy of anal fistula plug in fistula-in-ano: a systematic review . Colorectal Dis 12 : 965 - 970
4. Ortiz H , Marzo J , Ciga MA , Oteiza F , Armendáriz P , de Miguel M ( 2009 ) Randomized clinical trial of anal fistula plug versus endorectal advancement flap for the treatment of high cryptoglandular fistula in ano . Br J Surg 96 : 608 - 612 (...truncated)