Skip to main content

Advertisement

SpringerLink
Log in

Rectourethral Fistula: Operative Technique and Outcomes

  • Post-Prostatectomy and Acquired Voiding Dysfunction (V Tse, Section Editor)
  • Published:
Current Bladder Dysfunction Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Rectourethral fistula (RUF) is an infrequent yet distressing pathology that can lead to significant complications for patients. Its management has been debated over the years and physicians have yet to reach a consensus on RUF treatment. In this review, we outline the status of the current literature on RUF from the initial diagnosis to the outcomes, complications, and surgical techniques available for RUF repair.

Recent Findings

Higher rates of success are achieved on the first surgical attempt. Therefore, when deciding which surgical procedure to use, it is of vital importance to consider both patient characteristics (such as identifying if the fistula is simple or complex) and surgeon-related factors. Overall, many of the papers published reported good outcomes with several surgical techniques. However, most of the reports in the literature are retrospective in nature, reporting only small series with limited statistical merit. Through our analysis of the varying surgical techniques, we were able to identify the following suggestions: Conservative management should be performed with both urinary and fecal diversion, especially for simple fistulas. The transanal approach is an alternative approach for use in small simple fistulas as well as sealant glues. The transperineal approach has shown great results for complex fistulas in some series, but it also increases the risk for stress urinary incontinence. In some cases, the transsphincteric approach has been linked to fecal incontinence. Finally, the transabdominal approach in a robotic fashion may be a reliable technique. However, physicians must consider the high cost and the danger of invasion of the peritoneum before its use.

Summary

As of yet there is still not enough evidence to determine which surgical techniques are best for the varying scenarios of RUF. However, one point remains true for every RUF case: surgical repairs should only be done by an expert, after proper patient selection, and with the intention of both achieving success in the first repair. In order to advance our understanding of RUF occurrences and treatment, larger prospective and randomized studies are needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. • Nunez Bragayrac LA, Azhar RA, Sotelo R. Minimally invasive management of urological fistulas. Curr Opin Urol. 2015;25(2):136–42. Good overview of MIS principles for RUF repair in urological fistulas.

  2. Anderson KM, Gallegos M, Higuchi TT, Flynn BJ. Evaluation and management of rectourethral fistulas after prostate cancer treatment. Curr Bladder Dysfunct Rep. 2015;10(2):132–7.

    Article  Google Scholar 

  3. •• Mundy AR, Andrich DE. Posterior urethral complications of the treatment of prostate cancer. BJU Int. 2012;110(3):304–25. Great explanation on the basis of rectourethral fistulas and urethral complications overall.

  4. KN MS, Christis G, Anyfanti F, Sotirianakos S. Rectourethral fistulas: a challenging management problem. Hell J Surg. 2016;4(88):257–62.

    Google Scholar 

  5. Gupta G, Kumar S, Kekre NS, Gopalakrishnan G. Surgical management of rectourethral fistula. Urology. 2008;71(2):267–71.

    Article  Google Scholar 

  6. Theodorescu D, Gillenwater JY, Koutrouvelis PG. Prostatourethral-rectal fistula after prostate brachytherapy. Cancer. 2000;89(10):2085–91.

    Article  CAS  Google Scholar 

  7. Pisansky TM, Kozelsky TF, Myers RP, Hillman DW, Blute ML, Buskirk SJ, et al. Radiotherapy for isolated serum prostate specific antigen elevation after prostatectomy for prostate cancer. J Urol. 2000;163(3):845–50.

    Article  CAS  Google Scholar 

  8. Netsch C, Bach T, Gross E, Gross AJ. Rectourethral fistula after high-intensity focused ultrasound therapy for prostate cancer and its surgical management. Urology. 2011;77(4):999–1004.

    Article  Google Scholar 

  9. Sumitomo M, Hayashi M, Watanabe T, Tsugawa M, Noma H, Yamaguchi A, et al. Efficacy of short-term androgen deprivation with high-intensity focused ultrasound in the treatment of prostate cancer in Japan. Urology. 2008;72(6):1335–40.

    Article  Google Scholar 

  10. Ramirez-Martin D, Jara-Rascon J, Renedo-Villar T, Hernandez-Fernandez C, Lledo-Garcia E. Rectourethral fistula management. Curr Urol Rep. 2016;17(3):22.

    Article  Google Scholar 

  11. Hechenbleikner EM, Buckley JC, Wick EC. Acquired rectourethral fistulas in adults: a systematic review of surgical repair techniques and outcomes. Dis Colon Rectum. 2013;56(3):374–83.

    Article  Google Scholar 

  12. • Singla N, Morey AF. Rectourethral fistula reconstruction in elderly patients. Curr Opin Urol. 2016;26(2):171–6. Review focused on RUF management in complex settings such as the elderly.

  13. Chen S, Gao R, Li H, Wang K. Management of acquired rectourethral fistulas in adults. Asian J Urol. 2018;5(3):149–54.

    Article  Google Scholar 

  14. Nyam DC, Pemberton JH. Management of iatrogenic rectourethral fistula. Dis Colon Rectum 1999;42(8):994–997; discussion 7-9.

  15. Thomas C, Jones J, Jager W, Hampel C, Thuroff JW, Gillitzer R. Incidence, clinical symptoms and management of rectourethral fistulas after radical prostatectomy. J Urol. 2010;183(2):608–12.

    Article  Google Scholar 

  16. BJ JHC, Choi SG, Han EC, Ha HK, Oh HK, Choe EK, et al. Rectourethral fistula: systemic review of and experiences with various surgical treatment methods. Ann Coloproctol. 2014;1(30):35–41.

    Google Scholar 

  17. • Munoz-Duyos A, Navarro-Luna A, Pardo-Aranda F, Caballero JM, Borrat P, Maristany C, et al. Gracilis muscle interposition for rectourethral fistula after laparoscopic prostatectomy: a prospective evaluation and long-term follow-up. Dis Colon Rectum. 2017;60(4):393–8. One of the few prospective series in the literature on transanal repair.

  18. Kaufman DA, Zinman LN, Buckley JC, Marcello P, Browne BM, Vanni AJ. Short- and long-term complications and outcomes of radiation and surgically induced rectourethral fistula repair with buccal mucosa graft and muscle interposition flap. Urology. 2016;98:170–5.

    Article  Google Scholar 

  19. Imperatore V, Creta M, Di Meo S, Buonopane R, Fusco F, Imbimbo C, et al. Transperineal repair of a persistent rectourethral fistula using a porcine dermal graft. Int J Surg Case Rep. 2014;5(11):800–2.

    Article  Google Scholar 

  20. Kitamura H, Tsukamoto T. Rectourinary fistula after radical prostatectomy: review of the literature for incidence, etiology, and management. Prostate Cancer. 2011;2011:629105.

    Article  Google Scholar 

  21. Tran H, Flannigan R, Rapoport D. Transperineal approach to complex rectourinary fistulae. Can Urol Assoc J. 2015;9(11–12):E916–20.

    Article  Google Scholar 

  22. Razi A, Yahyazadeh SR, Gilani MA, Kazemeyni SM. Transanal repair of rectourethral and rectovaginal fistulas. Urol J. 2008;5(2):111–4.

    PubMed  Google Scholar 

  23. Bochove-Overgaauw DM, Beerlage HP, Bosscha K, Gelderman WA. Transanal endoscopic microsurgery for correction of rectourethral fistulae. J Endourol. 2006;20(12):1087–90.

    Article  CAS  Google Scholar 

  24. Nicita G, Villari D, Caroassai Grisanti S, Marzocco M, Li Marzi V, Martini A. Minimally invasive transanal repair of rectourethral fistulas. Eur Urol. 2017;71(1):133–8.

    Article  Google Scholar 

  25. Kilpatrick FR, Mason AY. Post-operative recto-prostatic fistula. Br J Urol. 1969;41(6):649–54.

    Article  CAS  Google Scholar 

  26. Lee KH, Lee MR, Pigazzi A. Robotic-assisted laparoscopic segmental resection with rectoanal anastomosis: a new approach for the management of complicated rectourethral fistula. Tech Coloproctol. 2013;17(5):585–7.

    Article  CAS  Google Scholar 

  27. • Dafnis G. Transsphincteric repair of rectourethral fistulas: 15 years of experience with the York Mason approach. Int J Urol. 2018;25(3):290–6. Extensive experience reported with the transsphincteric technique.

  28. Sotelo R, Mirandolino M, Trujillo G, Garcia A, de Andrade R, Carmona O, et al. Laparoscopic repair of rectourethral fistulas after prostate surgery. Urology. 2007;70(3):515–8.

    Article  Google Scholar 

  29. Sotelo R, Garcia A, Yaime H, Rodriguez E, Dubois R, Andrade RD, et al. Laparoscopic rectovesical fistula repair. J Endourol. 2005;19(6):603–7.

    Article  Google Scholar 

  30. Sotelo R, de Andrade R, Carmona O, Astigueta J, Velasquez A, Trujillo G, et al. Robotic repair of rectovesical fistula resulting from open radical prostatectomy. Urology. 2008;72(6):1344–6.

    Article  Google Scholar 

  31. Hechenbleikner EM, Buckley JC, Wick EC. Acquired rectourethral fistulas in adults: a systematic review of surgical repair techniques and outcomes 2013. 374–83 p.

  32. Verriello V, Altomare M, Masiello G, Curatolo C, Balacco G, Altomare DF. Treatment of post-prostatectomy rectourethral fistula with fibrin sealant (Quixil) injection: a novel application. Tech Coloproctol. 2010;14(4):341–3.

    Article  CAS  Google Scholar 

  33. Pera MAS, Pares D, Llorente A, Bielso O, Pascual M. Treatment of a rectourethral fistula after radical prostatectomy by York Mason posterior trans-sphincteric exposure. In: RM AZ, Wexner S, editors. Reconstructive surgery of the rectum, anus and perineum. 1st ed. New York: Springer; 2008.

    Google Scholar 

  34. Patrlj L, Kocman B, Martinac M, Jadrijevic S, Sosa T, Sebecic B, et al. Fibrin glue-antibiotic mixture in the treatment of anal fistulae: experience with 69 cases. Dig Surg. 2000;17(1):77–80.

    Article  CAS  Google Scholar 

  35. Bhandari Y, Khandkar A, Chaudhary A, Srimali P, Desai D, Srinivas V. Post-radical prostatectomy rectourethral fistula: endosopic management. Urol Int. 2008;81(4):474–6.

    Article  Google Scholar 

  36. Bardari F, D’Urso L, Muto G. Conservative treatment of iatrogenic urinary fistulas: the value of cyanoacrylic glue. Urology. 2001;58(6):1046–8.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. USC Urology Institute, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA

    Luis G. Medina, E. Rangel, I. Fuchs, M. C. Silva, A. Hernandez, G. E. Cacciamani & R. Sotelo

Authors
  1. Luis G. Medina
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. Rangel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. I. Fuchs
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. C. Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Hernandez
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. E. Cacciamani
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R. Sotelo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luis G. Medina.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Post-Prostatectomy and Acquired Voiding Dysfunction

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Medina, L.G., Rangel, E., Fuchs, I. et al. Rectourethral Fistula: Operative Technique and Outcomes. Curr Bladder Dysfunct Rep 14, 151–156 (2019). https://doi.org/10.1007/s11884-019-00529-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11884-019-00529-4

Keywords

Search

Navigation