Skip to main content

Advertisement

SpringerLink
Log in

Rectourethral Fistula Management

  • Kidney Diseases (G Ciancio, Section Editor)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Rectourethral fistula (RUF) is a rare condition that occurs, in most cases, as a consequence of prostate cancer treatments. Clinical suspicion and proper assessment prior to surgery are essential to adapt and successfully carry out an appropriate treatment plan. There are no randomized trials to guide clinical practice, and therefore, scientific evidence in this respect is limited. Expert recommendations seem to agree on the transperineal approach with flap interposition as the surgical treatment of choice in cases of complex fistulas, especially in those that have undergone prior radiation. Undoubtedly, the key to the successful treatment of the disease is the multidisciplinary and standardized management by physicians with experience in the field.

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

Similar content being viewed by others

References

  1. McBeath RB, Schiff M, Allen V, Bottaccini MR, Miller JI, Ehreth JT. A 12-year experience with enterovesical fistulas. Urology. 1994;44(5):661–5.

    Article  CAS  PubMed  Google Scholar 

  2. Tamam M, Yavuz HS, Hacimahmutoğlu S, MülazImoğlu M, Kacar T, OzpacacI T. Direct radionuclide cystography imaging in colovesical fistula due to inguinal hernia operation complication. Ann Nucl Med. 2009;23(7):693–6.

    Article  PubMed  Google Scholar 

  3. Gupta G, Kumar S, Kedre NS, Gopalakrisham G. Surgical management of rectourethral fistula. Urology. 2008;71:267–71.

    Article  PubMed  Google Scholar 

  4. Buckley JC. Complications after radical prostatectomy: anastomotic stricture and rectourethral fistula. Curr Opin Urol. 2011;21:461–4.

    Article  PubMed  Google Scholar 

  5. Vanni AJ, Buckley JC, Zinman LN. Management of surgical and radiation induced rectourethral fistulas with an interposition muscle flap and selective buccal mucosal onlay graft. J Urol. 2010;184:2400–4.

    Article  PubMed  Google Scholar 

  6. Thomas C, Jones J, Jäger W, Hampel C, Thüroff J, Gillitzer R. Incidence, clinical symptoms and management of rectourethral fistulas after radical prostatectomy. J Urol. 2010;183:608–12.

    Article  PubMed  Google Scholar 

  7. Chun L, Abas MA. Rectourethral fistula following laparoscopic radical prostatectomy. Tech Coloproctol. 2011;15:297–300.

    Article  CAS  PubMed  Google Scholar 

  8. Burri RJ, Stone NN, Unger P, Stock RG. Long-term outcome and toxicity of salvage brachytherapy for local failure after initial radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2010;77:1338–44.

    Article  PubMed  Google Scholar 

  9. De la Taille A, Benson MC, Bagiella E, et al. Cryoablation for clinically localized prostate cancer using an argon-based system: complication rates and biochemical recurrence. BJU Int. 2000;85:281–6.

    Article  Google Scholar 

  10. Blana A, Walter B, Rogenhofer S, Wieland WF. High-intensity focused ultrasound for the treatment of localized prostate cancer: 5-year experience. Urology. 2004;63:297–300.

    Article  PubMed  Google Scholar 

  11. Daniels IR, Bekdash B, Scott HJ, Marks CG, Donaldson DR. Diagnostic lessons learnt from a series of enterovesical fistulae. Color Dis. 2002;4(6):459–62.

    Article  CAS  Google Scholar 

  12. Blumberg JM, Lesser T, Tran VQ, Aboseif SR, Bellman GC, Abbas MA. Management of rectal injuries sustained during laparoscopic radical prostatectomy. Urology. 2009;73:163–6.

    Article  PubMed  Google Scholar 

  13. Keller DS, Aboseif SR, Lesser T, Abbass MA, Tsay AT, Abbass MA. Algorithm-based multidisciplinary treatment approach for rectourethral fistula. Int J Color Dis. 2015;30:631–8.

    Article  Google Scholar 

  14. McLaren RH, Barrett DM, Zincke H. Rectal injury occurring at radical retropubic prostatectomy for prostate cancer: etiology and treatment. Urology. 1993;42:401.

    Article  CAS  PubMed  Google Scholar 

  15. Uchida T, Sanghvi NT, Gardner TA, Koch MO, Ishii D, Minei S. Transrectal high-intensity focused ultrasound for treatment of patients with stage T1b-2N0M0 localized prostate cancer: a preliminary report. Urology. 2002;59(3):394–8.

    Article  PubMed  Google Scholar 

  16. Lane BR, Stein DE, Remzi FH, Strong SA, Fazio VW, Angermeier KW. Management of radiotherapy induced rectourethral fistula. J Urol. 2006;175:1382.

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  18. Mouraviev V, Spiess PE, Jones JS. Salvage cryoablation for locally recurrent prostate cancer following primary radiotherapy. Eur Urol. 2012;61:1204.

    Article  PubMed  Google Scholar 

  19. Acher PL, Hodgson DJ, Murphy DG, Cahill DJ. High-intensity focused ultrasound for treating prostate cancer. BJU Int. 2007;99(1):28–32.

    Article  CAS  PubMed  Google Scholar 

  20. Gelet A, Chapelon JY, Poissonnier L, Bouvier R, Rouvière O, Curiel L, et al. Local recurrence of prostate cancer after external beam radiotherapy: early experience of salvage therapy using high-intensity focused ultrasonography. Urology. 2004;63(4):625–9.

    Article  PubMed  Google Scholar 

  21. Fiaschetti V, Manenti G, DiPoce I, Fornari M, Ricci A, Agrò EF, et al. A rectourethral fistula due to transrectal high-intensity focused ultrasound treatment: diagnosis and management. Case Rep Radiol. 2012;2012:962090.

    PubMed Central  PubMed  Google Scholar 

  22. Voelzke BB, Garcia-Aguilar J, McAninch. Perineal management of complex rectourethral fistulae after prostate cancer therapy. J Urol. 2009;181:1185.

    Google Scholar 

  23. Andrews EJ, Royce P, Farmer KC. Transanal microsurgery repair of rectourethral fistula after high-intensity focused ultrasound ablation of prostate cancer. Color Dis. 2011;13:342–3.

    Article  CAS  Google Scholar 

  24. Forest S, Fassi Fehri H, Glachant S, Colombel M, Crouzet S, Ravier E, et al. Management of rectourethral fistulas with the York Mason procedure: surgical techniques and outcomes. Prog Urol. 2014;24(5):276–81.

    Article  CAS  PubMed  Google Scholar 

  25. Borowiec AM, McCAll M, Lees GM. The trans-sphincteric posterior sagittal repair of recto-urinary and rectovaginal fistulae using Surgisis mesh and fibrin sealant. Tech Coloporoctol. 2014;18:201–3.

    Article  CAS  Google Scholar 

  26. Ghoniem G, Elmissiry M, Weiss E, Langford C, Abdelwahab H, Wexner S. Transperineal repair of complex rectourethral fistula using gracilis muscle flap interposition—can urinary and bowel functions be preserved? J Urol. 2008;179:1882–6.

    Article  PubMed  Google Scholar 

  27. Solomon MJ, Tan KK, Bromilow RG, Wong JC. Bilateral puborectalis interposition repair of rectourethral fistula. Dis Colon Rectum. 2014;57:133–9.

    Article  PubMed  Google Scholar 

  28. Hanna JM, Turley R, Castleberry A, Hopkins T, Peterson AC, Mantyh C, et al. Surgical management of complex rectourethral fistulas in irradiated and nonirradiated patients. Dis Colon Rectum. 2014;57(9):1105–12.

    Article  PubMed  Google Scholar 

  29. Noldus J, Fernández S, Huland H. Rectourinary fistula repair using de Latzko technique. J Urol. 1999;161:1518–20.

    Article  CAS  PubMed  Google Scholar 

  30. 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  PubMed  Google Scholar 

  31. Mundy AR, Andrich DE. Urorectal fistulae following the treatment of prostate cancer. BJU Int. 2010;107:1298–303.

    Article  PubMed  Google Scholar 

  32. Venkatesan K, Zacharakis E, Andrich DE, Mundy AR. Conservative management of urorectal fistulae. Urology. 2013;81:1352–6.

    Article  PubMed  Google Scholar 

  33. York MA. Surgical access to the rectum—a transsphincteric exposure. Proc Roy Soc Med. 1979;63:91–4.

    Google Scholar 

  34. Bevan AD. Carcinoma of the rectum. Treatment by local excision. Surg Clin Chic. 1917;1:1233.

    Google Scholar 

  35. Kasraeian A, Rozet F, Cathelineau X, Barret E, Galiano M, Vallancien G. Modified York Mason technique for repair of iatrogenic rectourinary fistula: the Montsouris experience. J Urol. 2009;181:1178.

    Article  PubMed  Google Scholar 

  36. Dal Moro F, Mancini M, Pinto F, Zanovello N, Bassi PF, Pagano F. Successful repair of iatrogenic rectourinary fistulas using the posterior sagittal transrectal approach (York-Mason): 15-year experience. World J Surg. 2006;30:107–13.

    Article  PubMed  Google Scholar 

  37. Renschler TD, Middleton RG. 30 Years of experience with York Mason repair of recto-urinary fistulas. J Urol. 2003;170:1222–5.

    Article  PubMed  Google Scholar 

  38. Voelzke BB, McAninch JW, Breyer BN, Glass AS, Garcia-Aguilar J. Transperineal management for postoperative and radiation rectourethral fistulas. J Urol. 2013;189:966–71.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Samplisky MK, Wood HM, Lane BR, Remzi FH, Lucas A, Angermeier KW. Functional and quality-of-life outcomes in patients undergoing transperineal repair with gracilis muscle interposition for complex rectourethral fistula. Urology. 2011;77:736.

    Article  Google Scholar 

  40. Zmora O, Potenti FM, Wexner SD, Pikarsky AJ, Efron JE, Nogueras JJ, et al. Gracilis muscle transposition for iatrogenic rectourethral fistula. Ann Surg. 2003;237:433.

    Google Scholar 

  41. Sotelo R, Mirandolino R, Trujillo G, Garcia A, De Andrade R, Carmona O, et al. Laparoscopic repair of rectourethral fistulas after prostate surgery. Urology. 2007;70:515–8.

    Article  PubMed  Google Scholar 

  42. Linder B, Frank I, Dozois E, Elliott D. Robotic transvesical rectourethral fistula repair following a robotic radical prostatectomy. J Urol. 2013;189:164.

    Article  Google Scholar 

  43. Atallah S, Martin-Perez B, Parra-Davila E, deBeche-Adams T, Nassif G, Albert M, et al. Robotic transanal surgery for local excision of rectal neoplasia, transanal total mesorectal excision, and repair of complex fistulae: clinical experience with the first 18 cases at a single institution. Tech Coloproctol. 2015;19(7):401–10.

    Article  CAS  PubMed  Google Scholar 

  44. 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  PubMed Central  PubMed  Google Scholar 

  45. Amato A, Pellino G, Secondo P, Selvaggi F. Intersphincteric approach for rectourethral fistulas following radical prostatectomy. Tech Coloproctol. 2015;19(11):699–703.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Andrology and Urethro-Genital Reconstructive Surgery Unit, Urology Dept. Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Doctor Esquerdo, 46, 28007, Madrid, Spain

    Daniel Ramírez-Martín, José Jara-Rascón, Teresa Renedo-Villar, Carlos Hernández-Fernández & Enrique Lledó-García

Authors
  1. Daniel Ramírez-Martín
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. José Jara-Rascón
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Teresa Renedo-Villar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carlos Hernández-Fernández
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Enrique Lledó-García
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Enrique Lledó-García.

Ethics declarations

Conflict of Interest

Daniel Ramírez-Martín, José Jara-Rascón, Teresa Renedo-Villar, Carlos Hernández-Fernández, and Enrique Lledó-García each declare no potential conflicts 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

This article is part of the Topical Collection on Kidney Diseases

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ramírez-Martín, D., Jara-Rascón, J., Renedo-Villar, T. et al. Rectourethral Fistula Management. Curr Urol Rep 17, 22 (2016). https://doi.org/10.1007/s11934-016-0578-2

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11934-016-0578-2

Keywords

Search

Navigation