Abstract
Rectourethral fistula (RUF) may develop after ureterovesical and rectal intervention or radiation therapy (RT) rarely, but it is associated with significant morbidity and mortality. The patient will typically present with pneumaturia, faecaluria, and urinary drainage from the rectum. Diagnosis can be easily done with digital rectal examination, cystography, and urethrocystoscopy. Conservative supportive management of RUF does not appear to be successful in most patients, and management with surgical intervention remains the best treatment option. Several surgical techniques have been described including transabdominal, transanal, transperineal, combined abdominoperineal, anterior and posterior transsphincteric, transsacral, laparoscopic, robotic, and endoscopic minimally invasive approaches. There have been very few data about treatment of recurrent RUF. We would like to report the management of recurrent RUF following transurethral resection of prostate and RT for prostate carcinoma in an immunosuppressed, 75-year-old patient by York Mason posterior transrectal transsphincteric approach.
Highlights
Rectourethral fistula (RUF) is uncommon disorder but is associated with significant morbidity and mortality
The incidence of RUF after radical prostatectomy is less than 2%, 0.2% for brachytherapy, and 2.9% for combined external beam therapy and brachytherapy boost [1]
Keller et al determined the surgical approach based on five factors: severity of presenting symptoms, fistula size (>1 cm), extent of tissue damage from radiation or cryotherapy, status of the urethra, and presence of active pelvic sepsis at presentation [1]
Summary
Rectourethral fistula (RUF) is uncommon disorder but is associated with significant morbidity and mortality. RUF may occur after various conditions including urologic malignancy, pelvic trauma, inflammatory bowel disease, rectal surgery, and chronic infection [1]. The most common etiology of RUF is prostate procedures such as radical prostatectomy, transurethral resection of prostate (TURP), radiotherapy (RT), brachytherapy (BT), cryotherapy, or video-laparoscopic radical prostatectomy (VLS-RP) [1, 2]. The patient will typically present with pneumaturia, faecaluria, and urinary drainage from the rectum. Fever and fatigue are common symptoms [3]. The incidence of RUF after radical prostatectomy is less than 2%, 0.2% for brachytherapy, and 2.9% for combined external beam therapy and brachytherapy boost [1]
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