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

  • Cancer-Associated Voiding Dysfunction (S Elliott and J Pariser, Section Editor)
  • Published:
Current Bladder Dysfunction Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

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 Findings

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.

Summary

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.

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Abbreviations

RUF:

Rectourethral fistula

RP:

Radical prostatectomy

IBD:

Inflammatory bowel disease

XRT/AB:

Radiotherapy/ablative

DRE:

Digital rectal exam

AUS:

Artificial urethral sphincter

VCUG:

Voiding cystourethrogram

GGE:

Gastrograffin enema

References

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

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Authors and Affiliations

  1. University Hospitals–Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA

    Kirtishri Mishra

  2. Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH, 44106, USA

    Kirtishri Mishra

  3. Glickman Urological and Kidney Institute–Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA

    Nathan Y. Hoy, Hadley M. Wood & Kenneth W. Angermeier

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  1. Kirtishri Mishra
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  2. Nathan Y. Hoy
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Correspondence to Kenneth W. Angermeier.

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This article is part of the Topical Collection on Cancer-Associated Voiding Dysfunction

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Mishra, K., Hoy, N.Y., Wood, H.M. et al. Rectourethral Fistula—Review of Current Practices, Developments, and Outcomes. Curr Bladder Dysfunct Rep 14, 231–237 (2019). https://doi.org/10.1007/s11884-019-00544-5

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  • DOI: https://doi.org/10.1007/s11884-019-00544-5

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