經直腸超音波導引攝護腺切片後之直腸攝護腺尿道瘻管
個案報告及文獻回顧

周敬哲、吳翊豪、劉冠麟、林承家、陳文祥、林政鋒、陳鴻毅

基隆長庚紀念醫院 外科部 泌尿科

Recto-Prostatic Fistula as a possible complication related to transrectal ultrasound guided prostate biopsy – A case report and literature review

Ching-Che Chou, Yi-Hao Wu, Kuan-Lin Liu, Cheng-Chia Lin, Wen-Hsiang Chen, Cheng-Feng Lin,
 Hung Yi Chen

Divisions of Urology, Department of Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan

Recto-Prostatic fistula is a rare but devastating complication of prostate operations. Such cases are often involved in patients with locally advanced prostate cancer who had received treatments in forms of prostatectomy, cryotherapy, radiotherapy or in patients related with anorectal surgeries in rectal malignancies.

Transrectal ultrasound guided prostate biopsy is generally considered a relatively safe procedure and recto-prostatic fistula formations had only be reported in cases related with repeat biopsies.

We herein present a case with recto-prostatic fistula after first transrectal ultrasound guided prostate biopsy, sharing our experiences with reviews regarding its prevention, diagnosis and management.  

Case Presentation :  A 67 male patient who had received transrectal ultrasound guided biopsy of prostate presented to the emergency department 2 weeks following the procedure with urine retention and scrotal pain. CT survey showed prostate abscess formation with pararectal involvement.  The patient was taken to the operation theatre for drainage of prostate abscess due to unstable vital signs and irrigation fluid was noted expelling from his rectum during attempt for transurethral incision of prostate.  Colorectal surgeons were consulted and confirmed the diagnosis of rectal perforation, likely involved with recto-prostatic fistula formation.