Abstract
Rectourethral fistula (RUF) is perhaps the most feared complication following treatment for prostate or colorectal cancer. It has a significant impact on quality of life, usually requires a prolonged course of management, and may result in an unanticipated change in long-term treatment outcome. The authors have long been proponents of the perineal approach for repair of postsurgical and post-ablative RUFs, and have demonstrated a high rate of fistula closure with very acceptable short- and long-term complications with this approach. We have also primarily used this technique since 2004 with similar findings. It is a very well-tolerated procedure, which is important as many of the patients with post-ablative RUF are older with medical comorbidities. In addition, the perineal approach allows surgical access for concomitant urethral reconstruction and gracilis flap interposition as pointed out by the authors.
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