Management in robot-assisted radical prostatectomy patients with recto-urethral fistulas: the York–Mason technique

Purpose: To present the outcomes of the York–Mason procedure for managing recto-urethral fistula (RUF) after robot-assisted radical prostatectomy (RARP). Methods: A single-center retrospective cohort study was conducted at the Antoni van Leeuwenhoek Hospital–Netherlands Cancer Institute. Between January 2011 and May 2024, 12 cases of RUF following RARP, all treated with the York–Mason technique, were identified. Initial treatment involved conservative management with prolonged catheterization. If unsuccessful, surgical intervention followed. The York–Mason procedure is a posterior transsphincteric approach, providing direct access to the fistula through healthy tissue, with precise layer-by-layer closure of the sphincter complex. Successful repair was defined as the absence of anal urinary loss, the absence of fecal material in the catheter bag or pneumaturia, and the absence of leakage on cystogram. Results: Of the 12 cases of RUF, 10 occurred in patients who underwent RARP without radiotherapy (RARP-only), and 8 of these underwent York–Mason procedure as initial surgical treatment, achieving a 100% success rate after a median follow-up of 5.1 years (SD 2.9). The remaining two RARP-only patients initially underwent other surgical interventions, after which one achieved successful closure with subsequent York–Mason repair. The other two patients received both RARP and radiotherapy before fistula detection– one received radiotherapy prior to RARP, and one after. York–Mason was effective when radiotherapy preceded RARP. Conclusion: The York–Mason procedure provides promising results for managing RUFs in patients who have undergone RARP without salvage radiotherapy. Its effectiveness is particularly evident when used as the first surgical intervention.