Rectourethral Fistulae: The Perineal Approach

Abstract

Editorial Comment: Rectourethral fistulas are usually iatrogenic, occurring after treatment of prostatic disease. Fecal diversion is essential in complex cases and controversial in others. While an initial trial of fecal and urinary diversion alone may promote spontaneous closure, many patients will require open surgery. The authors describe excellent outcomes using a perineal approach via a prone jackknife position, conducted by a colorectal and urological surgeon. This transsphincteric approach allows repair of the rectal and urethral aspects of the fistula, including any complex membranoprostatic urethral damage. It is interesting that in several patients subsequent artificial sphincter implantation was successful despite extensive bulbar urethral mobilization during fistula repair.