Lipogems® Helps Repair Fistulas After Prostate Surgery

A Rare but Serious Post-Surgery Complication

A rectourethral fistula (RUF) is an abnormal opening that can form between the rectum and the urethra. This rare complication sometimes occurs after radical prostatectomy (surgery to remove the prostate for cancer treatment). When this happens, patients may notice stool or air in their urine—a distressing symptom that requires surgical repair.

Finding the best way to fix these fistulas has been challenging. Many techniques exist, but none has become the standard treatment. This study from Italy tested a new approach using Lipogems® technology to help heal these difficult wounds.

Seven Patients Treated with Combined "RAFAL" Technique

Researchers developed a procedure they call RAFAL (Rectal Advancement Flap plus Adipose Lipofilling). This approach repairs the fistula from both sides. On the rectal side, surgeons remove the abnormal tissue and create a flap to cover the opening. On the urethral side, they inject specially processed fat tissue containing regenerative cells.

Seven men with fistulas after laparoscopic prostate surgery received this treatment. Their fistulas ranged from two to five millimeters in size. All patients had developed symptoms within about two weeks after their cancer surgery.

Lipogems® Provides Your Own Healing Cells

Four of the seven patients received injections prepared using Lipogems® technology. Doctors collected about 150 milliliters of fat tissue from each patient's abdominal wall. The Lipogems® device then processed this tissue in roughly 20 minutes.

The system uses gentle mechanical action with small stainless steel spheres to separate the valuable healing components from unwanted material. This produces micro-fragmented adipose tissue (MFAT)—your own specially processed fat containing mesenchymal stem cells (regenerative cells that support healing). About 40 milliliters of this solution was then injected around the fistula on the bladder side.

86% Overall Success Rate with Long Follow-Up

The results were encouraging:

• Five of seven patients (71%) healed completely after the first RAFAL procedure

• Two patients experienced fistula recurrence and needed additional surgery

• One of these was successfully treated with a repeat RAFAL procedure

• Overall success reached 86% (six of seven patients healed)

• No complications occurred—either short-term or long-term

The median follow-up period was 53 months (about four and a half years), with some patients followed for over 13 years. This long observation period provides confidence that the repairs remained stable over time.

A Minimally Invasive Option with Clear Benefits

The RAFAL technique offers several advantages for patients facing this difficult problem:

• Uses your own tissue, eliminating risks from donor materials

• Minimally invasive approach through natural openings

• Relatively quick procedure (about three hours including fat processing)

• Low blood loss (less than 50 milliliters in all cases)

• No reported complications in this series

Patients stayed in the hospital briefly and were discharged with a urinary catheter. After confirming the fistula had healed (usually around two months), the catheter was removed. The temporary colostomy was reversed about five months after surgery.

What This Means for Your Treatment Decision

While this study is small—only seven patients—it demonstrates that combining tissue repair with Lipogems®-derived regenerative cells can effectively heal rectourethral fistulas. The 86% overall success rate and absence of complications are promising, especially for a condition that has historically been difficult to treat.

If you're facing a rectourethral fistula after prostate surgery, this research suggests that fat-derived regenerative therapy may offer a safe, effective repair option. Discuss with your surgeon whether the RAFAL technique might be appropriate for your specific situation.

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Source: Zuin et al., Techniques in Coloproctology, 2019.