Rectourethral Fistula—Review of Current Practices, Developments, and Outcomes

Abstract

Rectourethral fistula (RUF) is an uncommon pathology associated with a significant deterioration in quality of life. It can result from a variety of etiologies and frequently occurs in medically complex patients. Due to the involvement of both the urinary and fecal systems, there are a number of treatment considerations. The literature surrounding management of this condition is quite varied due to these factors. Recent literature on the field consists primarily of single institution case series, though there is a recently published multi-center cohort study with a relatively larger sample size. There is no clear surgical technique that appears to be superior. Transperineal repair is the most commonly described approach. In the properly selected patient, RUF repair results in success rates approaching 85–90%, though the definition of success is not standardized in the literature, and success rates are lower in patients post radiation or ablative therapy. This review highlights contemporary developments in the RUF literature, and provides an overview of important work-up and management considerations. Overall, there is no standardized protocol for management of RUF. Every case presents a unique challenge as a result of the RUF etiology, anatomical considerations, varying degrees of involvement of the genitourinary and gastrointestinal tracts, and patient comorbidities. Urologists must ultimately understand the disease process and utilize techniques that they feel most comfortable with.